The big news this week was that we have finally secured the vital funding we need to improve hospital services in Shropshire. On Wednesday, the Department of Health announced a major capital programme of £760 million for capital projects in England. Amazingly £312 million (about 40% of the total) has been allocated to the FutureFit programme which is improving the configuration of acute hospital services in Shropshire.
This is great news. It now means that we can get on and start the public consultation which has been repeatedly delayed. It means that in NHS England and the Department of Health and Social Care there is faith that we can deliver this much needed improvement in hospital services. Perhaps most importantly after a really dire winter, it gives hope to healthcare staff in Shropshire that we will be able to stabilise and then improve our services.
Here are the proposals:
Option1: The Royal Shrewsbury Hospital becomes an Emergency Care site and the Princess Royal Hospital becomes a Planned Care site
(This is the CCGs’ preferred option)
Option 2: The Princess Royal Hospital becomes an Emergency Care site and the Royal Shrewsbury Hospital becomes a Planned Care site
Under either option, both hospitals would have an Urgent Care Centre that is open 24 hours a day, seven days a week.
It looks like public consultation will start in early May. You can read the draft consultation documents here.
It looks increasingly likely that FutureFit will finally bring some proposals to a public consultation in October.
I anticipate that there will be significant interest in the effect of travel times to hospital on patients with time-critical illness and injuries. There have been many references to the golden hour in social media.
The literature on the effects of distance to hospital and mortality is mixed and it is difficult to compare results across different countries and health systems due to differences in practice. The 2007 paper by Nichol et al is often quoted . You can read the whole paper here if you are interested. Nichol looked at data from more than 10000 seriously people who were taken to hospital by ambulance in England between 1997 and 2001. Their data showed that increasing travel distances to hospital was associated with an increased risk of death, perhaps no surprise there. Importantly the authors say in the paper “Changes in performance in recent years or new policies that have changed to both increase distances and either improve care at the more distant facilities or improve the effectiveness of prehospital care could attenuate the potential effect of increased journey distance upon mortality.”
So what are the implications of this for reconfiguring our local health system in Shropshire? I think we should think of travel time as one component of the time between the onset of an illness and starting effective treatment. Other important elements to consider are dispatch time (ie time from calling 999 to an ambulance arriving), the time between arrival at hospital and seeing a senior clinician and the quality of the care received on arrival at hospital.
So there are precedents nationally for travelling further to improved services leading to improved outcomes. Locally in 2012 we centralised services for emergency general surgery at the a Royal Shrewsbury Hospital, within a year this had reduced the risk of death by 18%. In addition this made the service popular with consultants and trainee surgeons meaning that we can recruit when we need to. Now we just need to do the same for our other services ………..