Health care strategy must have a whole system approach to mending the NHS

From people turning up at A&E because they are not registered with a GP to those fit enough to be discharged from hospital but cant because the pharmacy is shut or there is not transport - councillors from both Shropshire and Telford and Wrekin debated the wide range of problems on Monday (19).

It followed a report from the Joint Health Overview and Scrutiny Committee's task and finish group which looked at Prevention, Primary Care, Urgent and Emergency Care, and Discharge in the local NHS.

The report calls for a look at current and future need in different communities and the capacity available to deliver social and health care, better data sharing between the hospitals and primary and social care, a better understanding of the end-to-end pathways through hospital and the different reasons for ambulance calls and emergency department attendance.

Councillor Claire Wild who chaired the group said it recognised the dedication of NHS staff and the public frustration over the problems.

She said an international report recommended that there were three hospital beds per 1,000 people.

"We have 1.6 per 1,000 and that includes the Orthopaedic at Oswestry," she said.

"There is no silver bullet and we must all work together."

"There is now a discharge ward at the hospital. Yet still someone can be fit for discharge but they have to have somewhere to go they need medication and they need transport."

"Almost half don't get discharged because they don't have this."

Councillor Heather Kidd said the task and finish group also looked at adult social care - recruitment and retention of staff and delivering the package of care.

"Something needs to be done quickly not in three or four months because we are experiencing winter pressures now."

The waiting times for A&E were debated with one of the problems said to be people who do not have a GP turning up there because they knew they would see a doctor.

Councillor Derek White said: "We need all the system to work and not have people waiting for ambulances and waiting in A&E. They system has entirely broken down."

Nicola Dymond from Shropshire Telford and Wrekin Integrated Care Partnership said the partnership was looking at whether hospital beds were in the right place, how many people were going into A&E and other date to produce a strong snapshot of what is happening everywhere.

"That review is completed and a couple of weeks into the new year we can look at finding some solutions to what's happened in our system and why."

Task and Finish group member, David Sandbatch said: "What upsets me is that with performance metrics we are performing worse but we don't have the quantity of deprivation as in other areas that are doing better than us."

"Our hospitals are a victim of excess demand elsewhere in the health service."

The group said it was vital that the Integrated Care Partnership looked at the problems of rurality and took into account cross border facilities as many Shropshire residents were registered to GP practices in Wales.