This document provides information about proposed changes to hospital services in Shropshire, Telford and Wrekin. It summarizes the context requiring changes, including difficulties retaining specialists and an aging population. Four options for changes are outlined, with the preferred option being to move some services between existing hospitals. Specific proposals include consolidating children's and maternity services at the Princess Royal Hospital and acute surgery at the Royal Shrewsbury Hospital. Public consultation on the proposals is open from December 2010 to March 2011. Feedback is invited online, by letter, or by attending public meetings. The changes aim to improve safety and quality of services for the long term.

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

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

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

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 Telford & Wrekin Powys
170,000; fast-growing
290,900; ageing population;
62,000 of 131,900;
Ageing; Increasing birth rate Ageing
Rural deprivation Densely populated; high Rural deprivation;
High life expectancy; levels of deprivation; Sparsely populated;
Higher than Higher than average Good health status
average/ rising levels of obesity, compared to Welsh
levels of LTC‟s smoking-related
• Shropshire admissions and deaths
averages
and cardio-vascular
disease

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 Option 3: Concentrate all
maintain all services as they services on one site, either
are. in a brand-new hospital - or
in one of the existing two
hospitals.
Option 2: Move some Option 4: Concentrate all
services from PRH to RSH major urgent inpatient and
and vice versa to make the emergency activity on the
most effective use of staff, site of one of our existing
equipment and buildings. 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
This would cost = £350 - £400 million +
This was looked at in a feasibility study in 2009.
In the financial climate now facing the nation, that
money is not available – so it is is not affordable or
feasible

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

25. The PCTs „Preferred Option‟ for PRH
Midwifery Led Units would remain on BOTH SITES
All women would receive their antenatal and postnatal appointments
at the SAME LOCATION AS NOW
• 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

26. Childrens services at PRH
• Inpatient 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)
 Major trauma (such as road traffic accidents) 24-hour A&E department
Outpatient clinics  Midwife-led maternity unit
 Day case procedures Children‟s assessment unit (not overnight)

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

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

42. Consultation questions

43. Consultation questions
What do you think about the overall proposals?
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?

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:
ournhsinsat@nhs.net

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 ournhsinsat@nhs.net

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
enquiries@telfordandwrekinlink.org.uk
or take part in an online discussion about Keeping it in
the County at www.telfordtalks.com

50. QUESTION TIME…..