Last month a joint letter from the six CLPs effected by the Future Fit Consultation was sent out to Dr Simon Freeman, Accountable Officer, Shropshire Clinical Commissioning Group and David Evans, Chief Officer, Telford and Wrekin CCG with twenty questions highlighting our concerns with the proposals. Just under a month later, we have received a reply. We have split the answers over two posts for better readability. A Press Release shall follow shortly that shall give our feedback on the answers provided.
June 15th 2018
Dear Mr Bradley,
Thank you for your letter dated 15 June 2018. We have set out our answers to your questions below:
1. The CCGs’ summary consultation document suggests that the public has made clear that two of its six priorities are that “NHS services should be more joined up” and that the NHS should “try to care for me at home, even when I am ill”. The original Future Fit plan promised an integrated ‘whole system transformation’ of our local health and social care services. Why has this approach been abandoned? How can plans for the radical reform of hospital services proceed in isolation from improvements to local GP, social care, community and public health services?
Shropshire, Telford & Wrekin Sustainability and Transformation Partnership (STP) includes all partners from across health and social care, as well as the voluntary sector and patient groups. Together, we continue to work to drive system improvements and have identified a number of local priorities. These include Shropshire’s Care Closer to Home Programme, Telford & Wrekin’s Neighbourhood Programme and Future Fit, as well as other priorities which include primary care, frailty, mental health and cancer.
None of these delivery programmes work in isolation of each other as many have interdependencies which require close working arrangements and collaboration. They are also aligned to other work programmes, including strategic workforce developments, digital enablement and estates, and together they are working to deliver system transformation. Progress is captured and reported bi-monthly through the system governance framework with system leaders including NHS England and NHS Improvement.
2. The CCGs concede that “any option we choose would mean that some people would have to travel further for their emergency care or planned care”. In many urgent cases, there is a direct correlation between the time it takes to access emergency care and survival rates. Your letter categorically states that “there is absolutely no evidence that these procedures place either patients, or staff, at risk”. Can you guarantee that greater distances to the Emergency Centre at either the RSH or PRH and/or the additional time taken to refer a patient from an Urgent Care Centre to the Emergency Care site will never in any circumstances jeopardise his or her care or, in the most serious cases, survival?
National evidence tells us that in an emergency, such as a heart attack or stroke, getting patients to the right hospital to receive the right treatment leads to better outcomes. Paramedics routinely diagnose patients in an ambulance to make sure that a patient is taken to the right hospital for the most advanced treatment. This often means that a patient will travel further and may drive past an A&E department to get them to the right place. This is happening now as ambulances take patients from across Shropshire, Telford & Wrekin and mid Wales who have had a stroke and need specialist care to the Stroke Unit at the Princess Royal Hospital. Similarly, patients who need heart or lung surgery are taken out of county to Stoke-on-Trent. Both the West Midlands and Welsh ambulance services have been involved in the Future Fit process and support the delivery of this public consultation. We are continuing to have detailed discussions with them around developing detailed pathways and ensuring the best possible care for our patients.
The CCGs have also commissioned a specific ambulance modelling activity exercise to explore the potential impact of the proposed acute hospital reconfiguration on ambulance/ patient transport activity and produce a formal report for commissioners. This modelling will form part of the decision-making process after the consultation.
3. Either option will lead to increased pressure on ambulance services which, as we have seen this winter, are already struggling to cope in a predominantly rural area 3.5 times the size of greater London. Has modelling of post Future Fit demand been undertaken with West Midlands and Welsh Ambulance Services and, if so, what are its findings? In any event, will additional resources be available for the Ambulance Services from the CCGs or other sources and, if so, how much?
The CCGs have commissioned a specific ambulance modelling activity exercise to explore the potential impact of the proposed acute hospital reconfiguration on ambulance/patient transport activity and will produce a formal report for commissioners shortly.
4. The summary consultation document concedes that “any change to our hospital services would have an impact on travel for some of our patients, visitors and staff” and states that the CCGs are undertaking “work with public transport providers to look at ways in which public transport could be improved to both hospitals”. What practical measures have been agreed with the providers and how will they be funded?
A Travel and Transport Group has been established and all key transport stakeholders and patient representative groups are involved in this group. This group will work together to review transport services and identify ways in which travel and transport could be improved. This will form part of the decision-making process after the consultation.
5. Who will staff the Urgent Care Centres and what qualifications and experience will they have in assessing and/or treating the range of urgent cases they are likely to encounter?
The Urgent Care Centres will be staffed by highly skilled senior health professionals who are specifically trained to deliver urgent care for adults and children. This will include Advanced Practitioners, GPs and nurses.
6. Given the difficulties experienced in the local recruitment of doctors and nurses to work in urgent/emergency care, how do the CCGs anticipate that SaTH will fill posts in the Urgent Care Centres?
SaTH has an extensive five-year workforce plan that is well underway which incorporates clinical posts that will support the urgent care centres at both hospitals.
7. The CCGs claim that up to 60% of urgent/emergency cases can be treated at Urgent Care Centres. The Royal College of Emergency Medicine believes the figure is closer to 20%. Its Vice President Chris Moulton has said in no uncertain terms that “the idea that the problems of an under-staffed, under-bedded and underfunded health service can be solved by either restricting access to emergency care or by ‘diverting’ people away from A&E is ridiculous and has wasted lots of money. This is just more of the same old clap-trap!” On what evidence do you justify your claim and can you identify an Urgent Care Centre anywhere in the UK which has safely and successfully treated 60% of the patients it has seen?
Detailed discussions have taken place with doctors, nurses and therapists who work at our hospitals, with primary and community care staff, to look at the numbers of people who currently attend our A&Es and the type of conditions that they have. This has helped to develop the urgent care model and determine which patients in the future could be treated in an urgent care centre and which would need to be treated in an Emergency Department.
Based on SaTH’s data of A&E attendances, we believe that, in the future, around 60-65% of patients who currently attend our A&Es would be able to be treated at one of our 24-hour urgent care centres. This includes patients who have a minor cut, sporting injury or chest infection. The new centres would offer more services than our existing urgent care centres, including a greater range of diagnostics and mental health assessment rooms.
8. What is the CCGs’ contingency plan and its cost should the Urgent Care Centres fail to meet their 60% target?
Although we believe that 60%-65% of patients who currently attend our A&E departments would be able to be treated at one of our new urgent care centres, our clinical model will be designed to be flexible if these numbers decrease or increase.
9Is it the case that the proposed Urgent Care Centres will be run by a private company? If so, are you able to identify the company, its qualifications, the anticipated length and cost of the proposed contract and what contingencies will be written into the contract in the event of non-performance?
There has been no decision which organisation will run the Urgent Care Centre. This will be agreed following the outcome of the consultation.
10 The CCG’s summary consultation document suggests that the Emergency Centre ought to be based in Shrewsbury because “it would better meet the future needs of our older population, especially in Shropshire and mid Wales”. Yet it also proposes to relocate the consultant-led and in-patient Women & Children’s Centre from the PRH despite the fact that the majority of births, including ‘problem births’, are in the east of the county. Please explain the logic of this decision and the evidence on which it is based.
The West Midlands Clinical Senate has recommended that, for quality and safety reasons, women and children’s consultant-led inpatient services should be located alongside the Emergency Department on the Emergency Care site. Most women would continue to go to their local hospital for the care and treatment they need, where they would be able to access a midwife-led unit, maternity outpatients and scanning, Early Pregnancy Assessment Service (EPAS) and antenatal day assessment.