The document discusses proposals to reconfigure hospital services in Shropshire, Telford and Wrekin. It outlines four options, with the preferred option being to move some specialist services between the two main hospital sites. This would allow services to be consolidated in a more sustainable way while maintaining A&E departments and access to acute care at both locations. Public feedback is sought on the proposals through meetings and an online/postal consultation through mid-March 2011.

1. Telford & Wrekin LINk Have YOUR say about the future of our local hospitals Keeping hospital services in Shropshire, Telford and Wrekin PUBLIC CONSULTATION 9 December 2010 – 14 March 2011

2. Keeping it in County Securing the future of hospital services in Shropshire RAISING PUBLIC AWARENESS - the need for change - the options + benefits of reconfiguring hospital services - the consequences of not taking action in the near future

3. The case for change Keeping it in the County Securing the future of hospital services in Shropshire,Telford and Wrekin

4. The context 1. The level of external scrutiny by independent regulators, professional bodies/colleges AND patient ‘watchdogs’ is greater than ever 3. A drift of services ‘out of county’ – this could become even more of an issue 2 . Difficulty in recruiting (and retaining) specialists

5. The purpose of the changes “ The proposals reflect what the doctors who provide the services, and the GPs who send their patients to use them, think should be done to improve safety and quality and make sure these services are provided within Shropshire, Telford and Wrekin for a very long time to come.” “ They are most definitely not aimed at saving money or cutting services.”

6. THE PRINCIPLES underpinning the proposed reconfiguration Two vibrant, well-balanced, successful hospitals A commitment to having an A&E on both sites Access to acute surgery from both sites

7. Risks and Challenges Changes are needed because it is increasingly difficult to provide services SAFELY

8. Services that are particularly affected by these challenges inpatient surgery children’s services maternity care

9. The key issues

10. Population Demographics Serve a population of over 500,000 An ageing population Deprivation – rural and urban Long Term Conditions and lifestyle related illness Shropshire Shropshire 290,900; Ageing; Rural deprivation High life expectancy; Higher than average/ rising levels of LTC’s Telford & Wrekin 170,000; fast-growing ageing population; Increasing birth rate Densely populated; high levels of deprivation; Higher than average levels of obesity, smoking-related admissions and deaths and cardio-vascular disease Powys 62,000 of 131,900; Ageing Rural deprivation; Sparsely populated; Good health status compared to Welsh averages

11. THE QUALITY OF MATERNITY CARE

12. Ageing buildings ….. not fit for purpose Even if money is spent on the building, its future life span is limited to between five and ten years.”

13. Providing the right level of care for children in hospital With reduced numbers of children’s specialist doctors nationally, our paediatric consultants are increasingly concerned about staffing our two existing children’s units with the right level of doctors.

14. SURGICAL CARE - 24/7 Surgeons specialise today – so carry out a smaller range of more complex operations than in the past Increasingly skilled surgeons are able to deliver better results – patients benefit. BUT leads to fewer general surgeons which makes it difficult to organise services so that the right specialists are available at any time of day or night.

15. Decision time….

16. HOW were the proposals developed? Specialist doctors, nurses and GPs other health professionals responsible for running the services concerned. Patients and carers and a wide range of organisations that represent them

17. . 4 key tests BEFORE publishing their proposals an Assurance Panel was asked to check that the PCTs proposals met the 4 KEY TESTS laid down by the Secretary of State for Health: 1 . local GPs (who will be responsible for commissioning services) support the proposals; 2. local patients and patient representatives are involved 3. the need for reconfiguration is supported by clinical evidence ; 4. the changes proposed will enhance patient choice. AND ALSO : how far they believed the proposals would improve outcomes for patients in the future, and are affordable and sustainable .

18. 4 options Option 1: Do nothing and maintain all services as they are . Option 2: Move some services from PRH to RSH and vice versa to make the most effective use of staff, equipment and buildings. Option 3: Concentrate all services on one site, either in a brand-new hospital - or in one of the existing two hospitals. Option 4: Concentrate all major urgent inpatient and emergency activity on the site of one of our existing two hospitals,with planned activity at the other

19. Option 1: Do nothing and maintain all services as they are “ If we did nothing, we expect it would result in services being moved out of the Shropshire, Telford and Wrekin area altogether. In those circumstances, many patients would end up travelling greater distances to receive their hospital care.” “ This does not provide a practical and satisfactory solution to the problem we have outlined.”

20. Option 2: Move some services from PRH to RSH “ It would enable us to continue to provide all the hospital services we are currently providing. Most patients would receive their care at the same hospital as they do now. For some inpatient services, some people who currently use the Princess Royal Hospital would go to the Royal Shrewsbury Hospital and vice versa .” This is the PCTs preferred option

21. Option 3: Concentrate all services on one site, either in a brand-new hospital or in one of our two existing hospitals Building a brand-new hospital to replace both PRH and RSH would be the ideal. new facilities from scratch up-to-date equipment purpose-built accommodation all our staff and services together In the financial climate now facing the nation, that money is not available – so it is is not affordable or feasible This would cost = £350 - £400 million + This was looked at in a feasibility study in 2009 .

22. Option 4: Concentrate all major inpatient and emergency activity on one site, with planned activity at the other Many potential benefits – and strongly supported by clinical staff. But in practice there is more urgent and emergency activity than elective or planned activity. If we were to implement this option one site would not have very much work, but the other site would very busy - and without significant expansion in facilities, the service would be overwhelmed. Neither affordable nor feasible

23. The details: WHAT changes are being proposed?

24. Most outpatients would continue to go to the same hospital as now Under the proposals, some specialist services would move from the Royal Shrewsbury Hospital to the Princess Royal Hospital in Telford, and vice versa Most ‘day case’ patients would go to the same hospital as now

25. The PCTs ‘Preferred Option’ for PRH Establishment of a Women’s and Children’s centre on the PRH site The obstetric unit would move from RSH to PRH. The Neonatal Intensive Care Unit would move from RSH to PRH and be co-located within the Women’s and Children’s centre Consolidation of inpatient paediatrics onto a single site at PRH with enhanced Paediatric Assessment Units on both sites Head and Neck services would transfer from RSH to PRH due to the high level of paediatric activity Midwifery Led Units would remain on BOTH SITES All women would receive their antenatal and postnatal appointments at the SAME LOCATION AS NOW

26. Childrens services at PRH I npatient children’s services would be concentrated at PRH site, with both sites providing children’s assessment units Children attending hospital as an outpatient (the majority of children who use hospital services) would continue to go to the same hospital as they do now . * The neonatal intensive care unit (for newborn babies needing intensive care) currently on the RSH site would move to PRH site, so that it is in the same place as the consultant-led maternity unit and inpatient children’s services

27. Gynaecology + ENT services INPATIENT gynaecology services would be concentrated in future at the women’s and children’s centre within PRH. OUTPATIENT or day care gynaecological services would go to the same hospital as now. Head and neck services including specialist surgery for cancer patients, + Ear, Nose and Throat problems would be seen at PRH -800 children each year

28. PRH RECAP 24-hour A&E department Outpatient clinics Day case procedures Emergency medical service (e.g. heart attacks, serious chest infections) Midwife-led maternity unit Emergency and inpatient orthopaedic surgery Children’s inpatient unit Children’s assessment unit (24 hours) Consultant-led maternity unit Neonatal unit Inpatient head and neck services, including ear, nose and throat Inpatient gynaecology services and breast surgery services

29. The PCT’S Preferred Option – for RSH Improved facilities in the midwifery led unit at RSH Acute inpatient surgery at RSH site The establishment of a vascular surgical centre at RSH Improved facilities for cancer patients at RSH (with the support of Lingen Davies)

30. RSH recap 24-hour emergency surgery Emergency and planned inpatient vascular surgery Emergency and planned inpatient colorectal surgery Emergency and planned inpatient upper gastro-intestinal surgery Emergency and inpatient orthopaedic surgery Emergency medical service (e.g heart attacks, serious chest infections) Outpatient clinics Day case procedures Midwife-led maternity unit Children’s assessment unit (not overnight) Major trauma (such as road traffic accidents) 24-hour A&E department

31. All urgent medical cases including strokes, heart attacks and serious chest infections would go to the same hospital as now – supported by non-resident senior surgeons

32. A&E services The maintenance of a 24 hour A&E service on both sites Major trauma would continue to be seen at RSH Long bone trauma would be seen in both A&E’s

33. Stroke Services Urology services Urology involves treatment of the kidneys, bladder, urinary tract and prostate. Work is currently taking place to determine at which of our two hospitals inpatient urology should best be concentrated in future. The PCTs also want to discuss the local pattern of stroke services, taking into account how best to introduce new techniques and develop services in line with modern standards. Views are being sought about both services as part of the consultation.

34. ISSUES which still need to be addressed Extended travel time for a minority of patients Patient pathways will need to be agreed and understood by all Paediatrician cover at RSH for acutely ill and injured children being taken to the RSH out of hours (NB severely injured children are transferred to Birmingham now – this will continue) The potential need to transfer children safely between the two sites The needs of rural communities need to be responded to under a new configuration e.g. Powys and parts of Shropshire Improving The Health Of Our Community

36. What are the costs / funding implications?

37. Revenue implications No additional £/funding from commissioners Whilst not solving the Trust’s financial challenges, the changes will give opportunities to strengthen the Trusts financial position Will remove the current hold up on making changes- and create a new opportunity to look at current models of care and working practices

38. Capital Costs New build at PRH - Women’s and children’s centre RSH - refurbishment of existing facilities Both in the range of £27 - £30 million Discussions with NHS West Midlands regarding the level of capital support – likely to be in the form of a loan, repayable over 25 years Improving The Health Of Our Community

39. When might the changes happen?

40. Planning the changes Improving The Health Of Our Community Phase Objective Timescale 1a Discussion and Design Developing a robust proposal Option modelling August to November 2010 1b Assurance and Consultation Assurance process Public consultation November 2010 December 2010 to March 2011 2 Planning for Implementation Planning, securing finance and undertaking procurement April 2011 to April 2012 3 Implementing the Change Implementation commences Phased approach from April 2012

41. WHAT HAPPENS at the end of the consultation ? By the end of MARCH 2011 - all three boards will decide, in the light of the outcome of this consultation, whether and how far to proceed with the proposals . If the boards agree changes will start this Spring All the changes would be implemented by 2014. Not all the changes would necessarily take place at the same time or at the same pace. Patient safety would be a top priority at every stage in the process .

42. Consultation questions

43. Consultation questions What do you think about the specific proposals for inpatient children’s services? What do you think about the specific proposals for maternity services? What do you think about the specific proposals for ACUTE surgery? Are there any comments you would like to make about the location of urology? Or about the future pattern of local stroke services ? Are there any other comments you would like to make? What do you think about the overall proposals?

44. HAVE YOUR SAY This public consultation runs from 9th December 2010 to 14th March 2011. During that time the PCTs want to hear the views of as many people as possible about their proposals.

45. How you can get a copy of the full document OR SUMMARY full and summary consultation documents are available on request. EasyRead or large print are also available. Call 01952 580478 or 0800 032 1107 Or download from www.shropshire.nhs.uk www.telford.nhs.uk www.sath.nhs.uk www.ournhsinshropshireandtelford.nhs.uk

46. Feedback ONLINE : www.shropshire.nhs.uk www.telford.nhs.uk www.sath.nhs.uk www.ournhsinshropshireandtelford.nhs.uk or EMAIL to: [email_address]

47. Write a letter setting out your views FREEPOST RRZR-SZAA-BUBZ Reconfiguration of Hospital Services, Oak Lodge, William Farr House, Shropshire County NHS PCT, Mytton Oak Road, Shrewsbury SY3 8XL or EMAIL [email_address]

48. ATTEND A PCT MEETING Thursday 13th January 7pm - Shrewsbury Town Football Club Thursday 20th January 7pm - Oswestry Memorial Hall Wednesday 9th February 7pm - Craven Arms Community Centre Wednesday 16th February 7pm - Holiday Inn, Telford

49. Please copy your feedback to Telford & Wrekin LINk Suite 1, Conwy House St Georges Road Donnington Telford TF2 7BF 01952 614180 [email_address] or take part in an online discussion about Keeping it in the County at www.telfordtalks.com

50. QUESTION TIME…..