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In one of the longest-running local sagas in the NHS, HSJ has reported yet another twist in the now decade-long tale of Shrewsbury and Telford Hospital Trust’s emergency care revamp.

Regional leaders unveiled four options which form the outline case for overhauling services, the central aim of which is to create an “accident and emergency local” effectively offering a 24/7 urgent care centre at Telford, and move maternity and child inpatient services to Shrewsbury.

However, while Shropshire, Telford and Wrekin integrated care system officially chose “option 2” on the grounds of affordability, as it satisfies the main requirements of the scheme within £312m of national funding, they made clear that another, more expensive option, would bring more benefits.

Leaders argued “option 4” – which would also see a new health and well-being hub created and existing wards and outpatient facilities upgraded – would deliver the greatest clinical, workforce and operational benefits.

There is just one catch: that it would cost £534m, far beyond the existing spending envelope, and a rebuild would not complete until December 2029.

The options, published for the first time last week, are likely to spark significant debate in the 12 months it may take to build a business case.

President aims at target

The president of the Royal College of Emergency Medicine has said the four-hour emergency care target is “not the right answer” long term, despite promises from Therese Coffey that it will no longer be scrapped.

Katherine Henderson told HSJ that RCEM would welcome more focus on the target in the short term if it led to driving up standards.

But in an interview with HSJ, she said performance measures in the long term should account for the “journey” of acutely unwell patients.

NHS England had backed new metrics to replace the four-hour target, but neither NHSE nor the Department of Health and Social Care have clarified what the future holds for them. This has left services “in limbo”, Dr Henderson said.

Dr Henderson also told HSJ that virtual wards and urgent community response teams, though a good idea, will have limited impact this winter. She also questioned whether it was “sensible” of “honourable” to have such a high turnover of DHSC ministers in the middle of a crisis, and said government messaging about “protecting the NHS” has now led to “unrealistic” expectations among patients.

Also on hsj.co.uk today

In our weekly round-up of health coverage beyond HSJ’s walls, The Primer reports on reaction to Therese Coffey’s “ABCD” plan, and in North by Northwest, Lawrence Dunhill looks at new insights on what caused the collapse of One to One Midwives in 2019.