It’s one step forward two steps back for a controversial and long-running hospital reconfiguration plan that predates the promise of 40 new hospitals.

The Outline Business Case for Shropshire ICB’s ‘Future Fit’ plan to centralise emergency services in Shrewsbury and downgrade Telford’s Princess Royal Hospital has been rubber stamped at national level, and the go-ahead has been given to draw up a Full Business Case.

But there is no guarantee that the funding necessary to build the project as first proposed will be available. The plan was initially projected to cost £312 million, and that much was theoretically put aside, but the Strategic Outline Case in 2019 conceded that the cost had risen 60% to £498m.

But by early 2022 BBC reports were noting that the actual cost had risen to £500m – but that with pressure to limit the cost of the new hospitals programme to £400m, Shrewsbury & Telford Hospitals Trust (SATH) had been told to “told to come up with cheaper option,” since no more cash would be available.

Since then there has been last year’s massive wave of inflation that has sent building costs sky high, raising doubts over the eventual cost of anything vaguely resembling the Future Fit plan.

But the project, which has been hotly contested form the outset by campaigners and by Telford and Wrekin’s Labour-led council, which in 2019 referred the plan to the Secretary of State (then Matt Hancock) has also been thrown into question by two new reports.

One is from the Independent Reconfiguration Panel, which has endorsed the Future Fit plan on the one hand but rejected Hancock’s notion to rebrand the urgent care centre that would replace Telford’s A&E as an “A&E Local”.

The IRP has rejected this fudge, noting that the Royal College of Emergency Medicine: “do not support the term A&E Local for the urgent treatment centre in Telford because it is not a recognised term and could create confusion among the public. They explained that a patient with a serious and time critical condition, such as a stroke, heart attack or sepsis, could present to an A&E Local expecting the same level of care as a Type 1 emergency department, causing a risk to patients who attend a facility with much reduced capability.”

Campaigners have objected more fundamentally to the downgrading of the Princess Royal Hospital to an urgent care centre, which would leave Telford as the largest town in England without a 24-hour A&E. All emergency admissions would be centred in Shrewsbury, 16 miles away, raising serious concerns about access, and the inadequate numbers of beds in the scheme.

Other issues raised include the lack of any serious plan (or funding) to expand community health services, and Future Fit’s failure to address capacity and service issues in primary care, mental health and social care.

The current provision is already struggling to cope, according to a report by the Trust investigating 140 emergency care deaths in SATH’s two emergency departments between October and December 2022. It noted that SATH had recorded three times the national average rate of deaths in A&E in December 2022, and that factors including:

“ambulance off load delays, the ED running … at over 200% occupancy, length of stay in the ED over 21 hours for an in-patient bed … are contributing factors to a total increase in in-patient stay, harm events and mortality.”

It is thought likely that in departments with more adequate capacity patients would have died “on the wards” rather than in the A&E. However this seems to dismiss a death as a death, and ignores the conditions in which the patients died, and the lack of dignity for patients and their relatives in an overcrowded A&E.

So the report concludes with no discussion of the likely implications of the two emergency departments being merged in a single unit, and no recommendations on ED capacity or bed numbers – leaving the door open to a pruned back and scaled down cost-cutting Future Fit seeking to reduce bed numbers even further .

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