Shrewsbury and Telford Hospital Trust is in special measures because patient safety is being compromised. Telford A&E will close overnight for safety reasons. Rural maternity units, including Ludlow, are closed for live births. For safety reasons. Shropshire Council is axing £4 million from its public health budge despite the opposition of the director of public health. The council’s cabinet member for adult social care and public health is predicting “Armageddon” in public health services.
Soon, the medics will be saying its not safe to live in Shropshire. It is beginning to feel that way.
NHS Improvement has put Shrewsbury and Telford Hospital Trust into special measures. That’s because there are enough problems to believe that patient safety is being compromised.
Future Fit has crawled along. The maternity unit consultation will not happen until after a lot more babies are born. Maternity services are subject to an inquiry and a hearing on poor practice by some midwives. The constant turmoil and lack of direction means that it is hard to recruit the expert medical staff we need in our county. The NHS staff we have are working their socks off but they need enough resources to do their job.
The latest addition to the growing crisis comes from Shropshire Council. In 2013, county councils and unitary authorities were given a remit to promote public health and reduce health inequalities. Shropshire Council has a budget of £17 million to pay for its health promotion work. The council leadership wants to cut that by £4 million in April. That will involve scrapping a lot of services that are reducing poor health and reducing the impact on the NHS and adult social care budgets.
Among the services that could be scrapped are those that aim to reduce obesity; preventing diabetes; ending smoking, including among pregnant women; mental health programmes, including suicide prevention; preventing falls; promoting physical activity; personal, social and health education (PSHE) in schools; health check services; and early identification of atrial fibrillation.
In a paper to the Health and Adult Social Care Overview and Scrutiny Committee yesterday, Professor Rod Thomson, Shropshire Council’s Director of Public Health said:
“I do not recommend any reductions to the public health programmes that we currently commission… The outline proposals set out in this paper have been reluctantly put forward. They are not recommended as the medium to long term consequences for local people will adversely affect the health and wellbeing of local people. This will include later identification of life limiting illnesses and a rise in chronic disease.”
It must be unique for a Shropshire Council officer to make a criticism of a proposed policy. That’s a job normally reserved for councillors.
Early this morning, BBC Radio Shropshire was advertising that the cabinet member Lee Chapman and Rod Thomson would be interviewed after 8.00am. Only Councillor Chapman turned up and no reason was given for Professor Thomson’s absence. But even the normally cautious Chapman gave an astonishing interview.
Councillor Chapman blames the growing shortfall on underfunded adult social care. He said there would be a “very considerable potential impact” from the cuts. He blamed the Tories in Westminster. “It is absolutely sitting with the government.” Extra funding the chancellor announced in the last budget is not enough and is anyway short term.
When challenged by Eric Smith on why the Conservatives in Shropshire had not got more money for the health and social care needs of the county, Councillor Chapman said: “We are banging on the table, we are getting cross.” Central government are kicking it into the long grass. He admitted that Shropshire Council would be £15 million a year better off if it had raised council tax during its early years. “Hindsight is a wonderful thing.” The council is drawing down reserves. He found it difficult to justify spending more than £50 million on shopping centres.
From 2020, the public health funding from national government will no longer be ring fenced. So councils can spend it on anything. Councillor Chapman said:
“We need to plan for it not being there. Armageddon I would suggest.”
Armageddon for health prevention services. What Lee Chapman is saying is that public health services will be cut in 2019 and totally obliterated in 2020.
The crisis in local public services has been long brewing. Underfunding by the government means that the NHS is on its knees at times. Shropshire Council staggers from one crisis to the other. But the failure of management and political leaders to get a grip on delivering a modern cost-efficient service has made matters much worse.
Commercialisation of health services rarely seems to have delivered the goods. Modernisation doesn’t have to mean privatisation.[1] All this points to a reality that our public services have got so complicated that no one seems to know how to run them properly.
What we do know is that Whitehall and MPs have no clue how complex and expensive it has become to maintain the quality of life and indeed life itself.
When the politicians in power predict Armageddon, we know that Shropshire is truly in crisis.
Notes
[1]. Commercialisation has muddied the waters. NHS Property Services, which owns Ludlow Community Hospital, has refused to give me any information on how much it charges the health trusts that use the hospital to provide our healthcare. I only got a response after a complaint to the Information Commissioner. The headline of the eventual response reads:
We strongly believe releasing this information could prejudice our commercial interests by affecting our ability to engage in future procurements/contracts where similar services are being negotiated. Disclosure of the charges schedule, which sets out the distinct cost per service per year, increases this risk of commercial prejudice.
The trusts that use the hospital have no inhibitions about commercial confidentiality. For example, the community health trust will pay £651,786.42 to use the hospital buildings this year.