The future of the 16 beds at Bishop's Castle Community Hospital will be discussed at a Shropshire Community Health Trust (Shropcom) board meeting next week.
Board papers prepared for the meeting, which will take place in public at SPaRC Theatre in Bishop's Castle, show the recommended options bosses have to consider.
The beds were closed 'temporarily' in 2021 due to what the trust said were staffing shortages.
They have never reopened, with the trust blaming difficulties in recruiting staff as the reason.
The issue has sparked major frustration in the local community, and a dedicated campaign to restore the service, with hundreds joining a march over the issue last month.
The board papers show a number of options, but also reveal that the trust cancelled a service review, which it intended to use to inform its decision on beds.
A letter from the trust CEO, Patricia Davies, to the HR consultant tasked with leading the review, shows that the trust did not have complete records of its own efforts to recruit staff for the hospital – leading to the process being halted.
According to papers for the meeting the situation means that the board "cannot be assured that the recruitment efforts were reasonable and sufficient".
The board is recommended to accept the issue as fact and then agree to attempt to recruit fresh staff to keep the beds open.
But, the recommended option will also see the trust give notice that the beds will close – and will only rescind the notice if it can find the staff.
The recommended option asks board member to agree to "formulate a workforce and recruitment plan (as suggested by the HR Consultant in feedback) with clear targets as to the numbers and type of staff to be recruited, the activity to be undertaken and the timeline for completion".
It adds: "In the meantime, provide notice to the commissioner of the intention to withdraw from the inpatient service and to provide the commissioned activity over the remaining three community hospital sites.
"On completion of the recruitment plan, if the recruitment numbers have been achieved the trust would seek to rescind the notice provided and to re-open the beds. If the recruitment numbers have not been achieved, the notice would stand and the trust would withdraw from the inpatient service."
The board papers reveal that Tony McCarthy, the experienced HR consultant commissioned to carry out the review, told the trust its recruitment and workforce processes needed improvement.
A letter from Ms Davies to Mr McCarthy also outlines the reasons for pulling the plug on the review.
It states: "Further to our recent discussion I recognise the challenges you have faced in obtaining the required information and data from the trust in a timely manner to enable you to complete the thorough report we both wished to see.
"Whilst this has been in part due to the change in personnel and processes within the trust’s workforce team it is nonetheless disappointing. In addition, I understand that you have not been able to speak with all the stakeholders you wished.
"In the process of the preparation of the submission of the evidence to you by the trust we have identified gaps in our data and processes. I have therefore concluded that whilst the trust is able to provide you with some of the evidence of the recruitment we have undertaken, it is not a complete record.
"In light of this I have taken the difficult decision, with support from the trust chair, to halt the review as it is clear there is further work we need to do to provide the necessary information."
The paper also highlights the concerns over the consultation process around the decision on the future of the beds – with a GPs group saying it had been "excluded from these conversations".
The July 13 letter from Dr Caron Morton, chair of South West Shropshire Primary Care Network, said: "I am writing on behalf of South West Shropshire Primary Care Network and its constituent practices to express our concerns that we have not been informed of, or invited to participate in, any of the series of engagement events currently taking place regarding your potential handing back of the contract to provide inpatient care at Bishop's Castle Community Hospital.
"This lack of formal consultation fails the governance test of assessing impact on all services, and also fails one of the five levels of assurance, by not including all commissioners of services (the PCN is a commissioner).
"We strongly feel that this is a poor decision for the future of provision of community services to the people of South Shropshire and East Powys, which will have a significant impact on the work of practices and the PCN in future.
"We consider that as providers of primary care services we should have been consulted as significant stakeholders in the decision-making process and are concerned that once again primary care has been overlooked and excluded from these conversations."
The meeting will take place at 3pm on Thursday, September 7.