Matt Hancock’s decision to rubber-stamp highly contentious plans to downgrade Telford’s Princess Royal Hospital, moving A&E and women and children’s services to a new £312m hospital in Shrewsbury has brought the spectacle of local Tory MPs in total disarray.

Telford’s Tory MP Lucy Allan, perched uncertainly in a seat which has a Labour council and now stands to lose its emergency hospital services, has oscillated between denouncing NHS “bureaucrats” and “highly paid hospital managers who thought they knew what was best for us,” and blaming “the Welsh lobby” whose needs had been “prioritised over those of Telford”.

She is now apparently living in denial of the impact of the decision that has been taken, and on the one hand bending the ear of the Health Secretary with advice to withhold the £312m to finance the new hospital unless Telford retains a 24/7 consultant-led A&E, and on the other looking to her hero Boris Johnson to step in, claiming rather incongruously that:

“The NHS is at the heart of this Government’s domestic agenda …. This is not a Government that will take much needed hospital services from former mining towns, with poor health outcomes, to move these services to the Tory shires. … Future Fit is out of time and Boris Johnson must put a stop to it.”

By contrast her neighbouring Tory colleague Mark Pritchard, in the adjacent Wrekin constituency has happily accepted Matt Hancock’s decision to back the controversial Future Fit plan, arguing it’s now time to “trust the medical experts” and claiming the Independent Review Panel “say ministers should keep their noses out”.

However even Pritchard is not prepared to “trust the medical experts” on another Future Fit proposal – to shift women and children’s services from Telford to Shrewsbury – which he says he will fight to stop.

Both of these Tories with counterposed views are focused on the central fudge in Hancock’s decision: while giving the go-ahead to the reconfiguration plan, he baulked at the political impact of axing A&E services in Telford, which has a large, relatively deprived population with a growing proportion of over-65s. So he came up with a weasel phrase, which he hoped might diffuse some of the anger:

“Having listened to and accepted the advice of independent clinical experts, I have asked NHS England to come forward with proposals within a month on how they will keep the A&E in Telford open as an A&E Local so that the Princess Royal Hospital can continue to deliver the urgent and emergency care the residents in the growing town of Telford need.”

Of course nobody knows what an A&E Local is: the phrase is used vaguely once in the NHS Long Term Plan, but no example exists.

But the one thing local Tory MPs appear to agree on is building up a fanciful notion of the “A&E Local,” seeking to convince local people that it really means A&E services will remain in Telford. Mark Pritchard declares:

“I am also glad the Department of Health has made it clear that Telford’s A&E should be retained with a new state-of-the-art ‘A&E Local’ model. It incorporates the very latest cutting-edge thinking on how A&E care should be provided. This involves building on, and providing much more than the previously suggested Urgent Care Centre model. It means more consultant-led time at Telford. This is good news.”

Lucy Allan began with questions, asking “What I want to know is what is an A&E Local and what this will mean for my constituents,” but soon shifted to echo Pritchard’s insistence it means effectively retaining the A&E department that Future Fit proposed to axe: “I am seeking 24/7 consultant-led A&E at Telford.”

She went on: “The hospital trust has always been strongly opposed to this model and are continuing to resist this proposal.… It’s wholly unacceptable that SaTH can choose to opt out of providing services in Telford at their discretion. They need to compromise. They cannot have it all their own way. The NHS is a public service.”

However the Reconfiguration Panel’s report that was accepted by Matt Hancock stresses repeatedly the need to concentrate emergency services in a single site. Calling for the new model of hospital care to be “implemented without delay” the IRP pulls up well short of Hancock’s ambivalent proposal for an “A&E Local” and stresses the limited urgent care provision at Telford:

“The Panel has previously commented about the confusion caused by the inconsistent use of names and models across the NHS and it is hoped that the current national policy to implement a standard urgent treatment model will improve matters. …

“Accepting the constraint that acute admissions will not be available at PRH, the Panel agrees that the aim should be to provide as much clinically appropriate urgent care and treatment as possible at the hospital.”

However without beds for the most serious cases Telford will not have an A&E: it could be dangerously misleading to suggest otherwise. Indeed the “A&E Local” formula could cause problems and delays for patients who need to be admitted to a bed in Shrewsbury, but who would be in a “place of safety,” and therefore not a priority as far as emergency ambulance services are concerned.

On a wider view, the IRP report is striking for its lack of any explanation of benefit to Telford’s population from the Future Fit changes.

It contains no serious consideration of the needs of Telford’s  population which it admits has “higher than national rates of poor health with lower life expectancy and higher rates of people reporting long term limiting health problems or disability. Within the Borough, 15 areas are ranked in the 10 per cent most deprived nationally.”

Hancock and the IRP have now rejected the arguments of the Council and calls from Shropshire Defend Our NHS to retain both A&Es and expand community services.

But there are many more stages to go through before any new build, not least resolving what is meant by an A&E Local, and addressing the affordability gap between the plan and the £312m available.

The Shrewsbury & Telford Hospital Trust will need to develop an ‘outline business case’ for the changes setting out how the money will be spent: once this is agreed the trust must then develop a full business case before making its planning applications for any physical changes made to hospitals in Shrewsbury and Telford.

During this process there could be a legal challenge to the decisions that have been made.

Don’t hold your breath waiting for a conclusion.

Squeezing out Telford

The IRP report sets a worrying precedent, by accepting that once a Joint Health Oversight and Scrutiny Committee had been set up between Telford and Shropshire councils, the JHOSC became “the appropriate and only English scrutiny body with which the CCGs must consult on any proposals developed in respect of the Future Fit Programme.”

The JHOSC has proved an effective way for Shropshire and NHS bosses to sideline Telford council and brush aside its concerns. NHS England was no longer required to keep Telford informed or deal with them directly at all.

So when Telford council argued in challenging the Future Fit plans that the consultation with the JHOSC was inadequate in terms of both content and time allowed, the IRP response was to dismiss the complaint because – not surprisingly – the complaint “was not endorsed by the JHOSC or the other party to the JHOSC, Shropshire Council.”

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