Saturday, April 16, 2016

Montgomeryshire Health Service - Update.

Health is a devolved issue, but since most of our A&E and elective care are delivered in Shropshire, health remains a key issue for Montgomeryshire's MP. So I'm blogging about the subject. And it's not very positive about the way things are going.

Throughout my life, most people of Montgomeryshire (except for the Machynlleth and Llanidloes 'catchments') have depended on the Royal Shrewsbury Hospital (and increasingly the Princess Royal at Telford) for A&E and secondary care. These two hospitals are run as one trust. Western Montgomeryshire look to Bronglais at Aberystwyth for the same services, and the Tanat Valley look to Wrexham Maelor. Because of clinical advances in NHS provision, and the development of separate English and Welsh NHS structures, there is growing pressure for fundamental change - firstly within Wales, and secondly within Shropshire.

Let's consider position within Wales. In today's NHS world, a District General Hospital needs a far larger 'catchment' area to be sustainable. The current Bronglais 'catchment' has too small a population to support a full range of services. Many of us suspect (including me) that the Welsh Government would like to see the population of Newtown orientated towards Bronglais (rather than Shropshire) - though this is not a publicly declared position. Certainly no-one has raised this with the people of Newtown. Personally, I do not think the people of Newtown would be happy with the idea at all. Must admit I have not the slightest idea what the Powys training Health Board thinks - which is the way it's been for several years. Get more information out of the North Korean Secret Service. No confidence at all that this body is fighting our corner. 

In Shropshire, we have not much idea where structural change is heading. There was a recent major exercise referred to as Future Fit which cost £2million (I think) and sunk into a quagmire of indecision. Not sure where we are now. I've certainly heard nothing official. So it's crystal ball time. Firstly, the commissioning structure seems to have changed. The two Shropshire based CCGs (Clinical Commissioning Groups) seem to gave been semi-merged, which might be good. A plan is being considered, which involves A&E at either PRH or RSH, though with some similar services being available at an Urgent Care Centre developed at both hospitals. There's some ill-defined talk about a 60%/40% services split between both sites. I have little idea what this means in practice. The provision of Urgent Care Centres around Shropshire seems to have been dropped. Of greatest concern to me is that I'm told the cost of delivering the 60% is significantly cheaper at Telford than at Shrewsbury. What I do know is that it would be a disaster for Montgomeryshire if Telford got the nod. 

And then we have primary care. The previous strategic plan envisaged about 40% of those currently turning up at A&E being diverted to Urgent Care Centres, which seem to gave been dropped from current thinking. I cannot see how GPs can pick up this workload. Over stretched already. So where are these patients going to be treated? I'm looking forward to having latest thinking shared with MPs. After all, it's us who are going to be at the heart of the campaign to secure the funding needed to take forward the plans finally decided on. I suspect there will be an update on thus post in a few weeks time. Really hope so.

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