Tuesday, September 29, 2009

Wake up Powys - before its too late!

Longish post. Hugely important issue for Montgomeryshire. Two hours today locked in discussion with Shrewsbury MP, Daniel Kawszynski and Chief Executive of the Shrewsbury and Telford NHS Hospitals Trust, Tom Taylor. I'd asked for the meeting. Needed to get my head around the complexities of delivery of acute health services in Shropshire and Mid Wales. This issue really matters to the people of Montgomeryshire. We don't have a District General Hospital of our own anywhere in Powys. The Royal Shrewsbury Hospital is our local A & E centre. Let me outline the background to this issue.

There are four main bodies involved in delivery of health care in Shropshire. Two service commissioners - a) The Shropshire Primary Care Trust, and b) The Telford and Wrekin Primary Care Trust. And two service providers - a) The Shrewsbury and Telford NHS Hospitals Trust, and b) The Robert Jones and Agnes Hunt NHS Orthopaedic Hospital Trust. About a year ago, these four bodies agreed to review the overall delivery of services across Shropshire and Mid Wales, and put forward proposals for reorganising them from around 2012/13 onwards. The most contentious aspect of these proposals involves the location of serious A & E services on a single site, either Shrewsbury or Telford - rather than on both sites as is currently the position. The favoured site is Shrewsbury, a decision which has quite understandably caused a conflagration of objection in Telford. Incredibly, there has been almost no reaction in Montgomeryshire at all. I've never seen such rampant complacency. The whole of Powys and Shrewsbury had better wake up, and wake up pretty damn quickly, or the huge well-organised campaigns already underway in Telford will lead to the recommendations being reversed, and A & E services being removed from Shrewsbury.

So what do Daniel K and I want to happen. Firstly, we believe that it would be sensible to delay the change for as long as possible. The impetus behind the proposed change is to ensure that the service remains clinically safe. The only way to avoid implementing the change would be the transfer of spending within the Shropshire NHS into the recruitment of more consultants - because this is where the problem lies. More are needed, (to provide the same service) because of the introduction of the Working Time Directive, and today's increased specialisation by consultants. The current intention is that a consultation on the proposals will be held in early November. Our message was that this should be delayed if possible. However, we realise that the consultation may well go ahead. So our second objective will be to try to arrange a meeting between representatives of Powys Council, Powys LHB, Shropshire County Council, and the Shrewsbury Council as soon as possible - to try to instill some urgency into the case for retention of A & E services at 'our hospital' in Shrewsbury. So its 'wake up Powys' - before its too late.


Helen said...

Thank you for bringing this to our attention Glyn, but surely when you think of the area these two Hospitals cover, there should be an A&E dept at both!!

Glyn Davies said...

Helen - I agree with you, but there is insufficient money available in Shropshire to provide two separate, clinically safe A & E departments. The Working Time Directive means that many more consultants are needed to cover the same work. And consultants are more specialised today, which means more are needed to ensure clinical safety. And our 'blame' culture ensures that if an official report landed on the Cheif Executive's desk informing him that a service was 'clinically unsafe' he would be under a lot of pressure to just close it down there and then.

Anonymous said...

When is this consultation taking place in powys?

Glyn Davies said...

Anon - There are no plans to as yet. Personally I still hope that a solution to the problem can be found which will delay the change (and also the consultation) for at least a year. The current intention is that the consultation should start on Nov 2. If it does go ahead I will ask that a meeting is held in Montgomeryshire - and if it isn't arranged by those who should do it, I'll do the smae as last time, and organise it myself!

Anonymous said...


You say wake up Powys on this matter but I would like to say wake up Tories on another matter.
The Tories want to wake up to the fact that every Tory member in the chamber in the Assembly yesterday voted FOR the introduction of EID!
So much for supporting the farming industry in Wales. And your leader wasn't even in the chamber to vote! But then perhaps he would have voted for the introduction of EID like the rest of you sorry bunch?

Unixman said...

It will put Oswestry in a pretty pickle too... I see casualties/admissions going to the Maelor with all the funding concequences of that ...

Unixman said...

Update Glyn

Seen this?


Glyn Davies said...

Anon - Cannot answer this one at present. As far as I knew, our Assembly group was totally opposed to EID. There must be some reason behind this. I will find out what is going on.

Unixman - Indeed it will. And I cannot access the page for some reason to know what it says.

Unixman said...

C&P jobbie ....

Update for Staff – 28 September 2009
Many of you will have seen the recent media coverage relating to the proposed changes to a small number of hospital services in Shropshire, Telford and Wrekin. Some of this coverage hasn’t been accurate so in this staff update we’re concentrating on the key facts to keep you up to date.
The previous staff briefings have described in detail how the proposals made to Shropshire County PCT, NHS Telford and Wrekin and The Shrewsbury and Telford Hospital Trust Boards last week have been developed.
The main points are:

Ensuring clinical safety and good quality patient services for the future are the reasons for these proposals.

They are based on the work of senior local doctors, nurses and health professionals over the last eighteen months.

The proposals noted by the Boards this week are proposals and no decisions will be made without public consultation.

They are made on the basis of in depth studies and work completed over a period of eighteen months and involving clinical staff, management staff, external organisations and members of the public and patients.

No hospital closures will take place as part of these proposals.

In the proposals for 2012/13, A&E and paediatric services will remain at both the Princess Royal Hospital (PRH) and the Royal Shrewsbury Hospital (RSH) in the medium term.


Unixman said...

pt 2 (to get past the 4096 char limit on comments)
t is parts only of those services that are proposed to be based at either one hospital or the other, that is, the major trauma part of the accident and emergency service, plus emergency surgery and overnight (inpatient) children’s services. Children’s assessment units would remain at both hospitals and a new children’s “Hospital at Home” service would be developed.

At their meetings, all the Boards accepted that the technical assessments show that the option which concentrates these services at RSH could bring the service improvements faster and more cheaply.

For the longer term of 2020, the proposal is for a new hospital on one site – either PRH, RSH or a new site in between. Boards accepted technical work showing that all these site options are potentially feasible.
The options for the interim period (2012/13) which will be a stepping stone to the long term solution in 2020 are:
Princess Royal Hospital (PRH)
Royal Shrewsbury Hospital (RSH)
Level 3* A and E, urology
Level 2* A and E with acute surgery, inpatient paediatrics, obstetrics and neonates
Level 2* A and E with acute surgery, inpatient paediatrics, obstetrics and neonates
Level 3* A and E, urology
Level 3* A and E with inpatient paediatrics, urology
Level 2* A and E with acute surgery, obstetrics and neonates
Level 2* A and E with acute surgery, and inpatient paediatrics
Level 3* A and E, obstetrics and neonates, urology
*Level 3 A&E – If a football player breaks his leg, or an elderly lady falls and fractures her hip, he or she would still be able to go to either PRH or RSH.
Level 2 A&E - However, if a teenager is involved in a serious car accident and has multiple injuries, he/she would be taken to either PRH or RSH for specialist care depending on the outcome of the review.
Both PCT and the Hospital Trust Boards have noted at their meetings this week that Option 1 for the medium term reconfiguration of specific hospital services (please see Options above) scored more highly than the other options on non-financial considerations, had the lowest capital cost and the shortest construction period and have agreed that Options 3 and 4 will no longer be considered as they both had a much lower assessment. The Boards have also agreed that detailed plans for children’s Hospital at Home and the development of the paediatric assessment services at RSH and PRH should be drawn up and implemented.
The Boards also noted that all three options for the 2020 single site (at PRH, RSH or a site in between) have the potential to be technically and financially feasible, and agreed that a full option appraisal should be carried out on all three options. They also agreed to further detailed discussions on care closer to home with primary care, social care, the voluntary and independent sectors and other key partners, which will shape the background information to inform planning for a new hospital.
The Boards will be meeting again in October to consider more immediate proposals from The Shrewsbury and Telford Hospital Trust for mitigating clinical risks in the immediate term and will then be agreeing a date for full public consultation.
Consultation could either:
-start later this year on the 2012/13 proposals and the principle of a single site hospital (but not with a preferred specific location as that work has not yet been done)
or, if there are immediate improvements that can be made to sustain the current service arrangements with high quality for longer, then consultation could be delayed until more work has been done to look in detail at the possible sites for a new 2020 hospital. The consultation could then tell the public the whole story of both the 2012/13 changes, and which location for a new 2020 single site option offered most benefits.
This is what the Boards will be considering again in October.
Further information is available on the dedicated website: www.ournhsinshropshireandtelford.nhs.uk or please e-mail the programme team at: ournhsinsat@nhs.net

Tcoah said...

Glyn: check your email/inbox - the Health care document alluded to by Unixman is there (for your perusal I just emailed it to you).

Gordon said...

This is a case where the devolution settlement must be reviewed. We need to take power away from the assembly to create an overarching cross-border health body. I understand that the Conservatives are considering doing this very thing.