Your letter, based as it is on assertions and assurances, does little to allay our fears that Future Fit is driven more by the need to reduce costs in response to year-on-year shortfalls in Government funding than by a well-conceived and funded strategy to improve our local health services.

Indeed, the CCGs’ summary consultation document itself clearly states that “we need to be moreefficient with our limited resources” and your letter, in referring to current arrangements at the PRH and RSH, confirms that “we cannot afford them within allocations”. You warn that “objecting to theFuture Fit programme thinking something better will turn up is to live more in hope than the realityof what we have before us”. The suggestion that Future Fit might represent the least worst option is hardly confidence-inspiring.

But these observations go to the heart of our objections to Future Fit. We agree that the status quo is unacceptable. As we have made clear, we are not opposed to change. But we insist that it has to be for the better and for the long term. The problem with Future Fit is that neither of the options will improve local services, either would lead to the downgrading of one of our hospitals and both will lock in decline in our health provision for a generation.

As neither your letter nor the consultation materials the CCGs have made available to the public adequately address the important issues we have raised, it may be helpful to set out a series of straightforward questions, to which equally straightforward replies would be appreciated.

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?
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?
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?
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 whichpublic transport could be improved to both hospitals”. What practical measures have beenagreed with the providers and how will they be funded?
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?
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?
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 problemsof an under-staffed, under-bedded and underfunded health service can be solved by eitherrestricting access to emergency care or by ‘diverting’ people away from A&E is ridiculousand 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?
8. What is the CCGs’ contingency plan and its cost should the Urgent Care Centres fail to meet their 60% target?
9. Is 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?
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 olderpopulation, especially in Shropshire and mid Wales”. Yet it also proposes to relocate theconsultant-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.
11. The CCGs’ summary consultation document states that if emergency and planned care areseparated, “it would be highly unlikely that planned surgery would be cancelled due to anemergency admission”. Can you also guarantee that bed shortages at the emergency care sitewill never require transfers to beds at the planned care site and, in consequence, lead to the cancellation of planned care treatments?
12. Will both hospitals have pathology labs and MRI/CT scanners or in urgent cases will patients and samples have to be transferred between hospitals? If the latter, are the CCGs confident that ambulances or other NHS services will always be available to transport them? What resources have been set aside for such a contingency?
13. How much of the £312 million cost of Future Fit will be raised from private finance and what model will be involved; what is the anticipated annual cost of repaying it and over what term?
14. What NHS land is proposed for sale and what receipt is expected from the sale?
15. What is the annual cost of the interest on the £200 million Public Dividend Capital and for what term?
16. How much of the £312 million will be spent on repairing or converting existing buildings and how much on new buildings?
17. How many fewer staff, both permanent and temporary and in what categories, will Shropshire’s NHS employ when Future Fit is implemented?
18. The CCGs’ consultation materials provide very little detailed information on the Future Fit proposals and how they will be funded and there are no open public meetings at which they can be questioned or debated; how confident are the CCGs that they comply with the Gunning Principles which require that in any consultation the public must “have enough information to make an intelligent choice and input in the process”?
19. The CCGs’ consultation questionnaire is not being widely circulated and respondents are not asked to identify themselves which means that false or multiple responses cannot easily be avoided. How can the CCGs be confident that the consultation will genuinely reflect public opinion; how will they analyse the public response and what influence will it have on the final decision?
20. Can you provide an assurance that no pressure has been applied by senior management to prevent local NHS staff from expressing their concerns about Future Fit?