There have been two announcements about Future Fit recently. The Future Fit team scrapped the option of building a £500 million plus A&E hospital on a greenfield site between Shrewsbury and Telford. Now, it has delayed a decision on where Rural Urgent Care Centres will go in the county. As it does so, we fear that Ludlow Hospital services are being reduced by stealth. Its future may be a hospital without beds run by overstretched GPs.
The Future Fit programme began with a theoretical model of how you might reshape the local health service in a perfect world. A world where health needs and costs aren’t rising rapidly. A world where public money is not in short supply. A world where existing, even brand new facilities, can be bulldozed and rebuilt. We don’t live in that world.
The idea of having a brand new A&E hospital between Shrewsbury and Telford was always a non-starter. It would cost more than half a billion pounds and we don’t have that sort of money anymore. In our view, the only location for an A&E that will meet the needs of the rural communities in Shropshire and Powys is in Shrewsbury.
Now at least the Clinical Commissioning Group has set aside a pot of £5.3 million a year for community care and Urgent Care Centres (details are in CCG the board papers). But providing extra services at the current community hospitals to ensure they meet UCC standards will cost between a quarter of a million and a million pounds for each site. The total comes to £3.1 million for the five rural UCCs and the UCC in Shrewsbury.
New community health services will have to be paid for out of the same pot. The estimates of costs for ‘Community Fit’, the partner of Future Fit, are “the least developed in terms of financial modelling” according to the board papers. The estimates at the moment are an additional cost of £2.6 million.
So the costs of Community Fit and the UCCs is already £5.7 million on a budget of £5.3 million.
There is a general push to provide more health services in the community. We think this is the right way to go. But we can’t help feeling that these estimates are underestimated. Providing health services in rural communities costs more. Patient numbers are lower than in urban areas so there aren’t the same economies of scale. Travel costs are higher and health staff have to spend more time travelling. It is also proving hard to recruit staff.
The reality is that there is not likely to be enough money for five UCCs in rural Shropshire. With Ludlow set to be the second most expensive UCC, this still leaves our hospital at risk of losing a bed-based hospital.
That’s what Jan Ditheridge, chief executive of the Community Health Trust, implied at the meeting hosted by Philip Dunne last Wednesday evening. She said we should perhaps be thinking of a Ludlow Hospital without beds.
(Jan was due to meet Andy on Friday and this issue would have been top of his questions, but she cancelled at the last minute.)
All the indications suggest that our hospital won’t become a UCC but a sort of community hub for health facilities.
Closure of beds will mean that sick and ill people will need to travel to Shrewsbury to Telford when they could often be treated in Ludlow. We have already had the number of beds cut by half at Ludlow Hospital. Ludlow patients returning from acute care to recuperate are being placed in beds as far away as Leominster, Bishop’s Castle and Bromyard. There is no longer any occupational therapy at our hospital. It seems we are becoming a community hub by stealth.
In a letter to GPs last week, Dr Caron Morton of the CCG announced that a decision on Rural Urgent Care Centres is to be further delayed.
We are seriously worried that rural health services are being wound down while we await a decision on Future Fit. I fear that the bed-based operation at Ludlow Hospital is being closed by stealth. Under Future Fit, we may still have a hospital in Ludlow but with no beds. That will put a huge strain on our local GPs. They will need more resources, more staff and the time to put them in place.
Only two years ago, there was hope of a brand new hospital for Ludlow on the Eco Park. Now we are facing the loss of our community hospital in all but name.
The problem with Future Fit is that it is wedded to a rigid model of provision, a complex hierarchy of facilities. We need a more practical, flexible model which makes best use of existing resources and fully recognises the rural nature of much of this county.