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Dispirited NHS chiefs behind a long-delayed overhaul of a troubled trust’s emergency care provision are no doubt reeling after yet another setback.

Reconfiguration of Shrewsbury and Telford Trust’s A&E services under the hospitals transformation programme, a scheme which has faced significant political pushback over the years, was dealt another blow when NHS England sent outline proposals back for “further work”.

The move by national commissioners was despite SaTH finally submitting an outline business case in October 2021, almost three years after proposals were greenlit following a public consultation and nearly four years since £312m was allocated to finance the shake-up.

However, it is HSJ’s understanding that inflation has now pushed up the overall value of the scheme.

It means the bid, which would see an “A&E local” installed at Princess Royal in Telford and a main ED kept at Royal Shrewsbury, is now expected to cost significantly more to deliver than that rubber-stamped in 2018.

Despite this, it has now emerged through a parliamentary question response that SaTH must provide an option compliant with the original money, in order to help the plans over the line.

Final thoughts

Our interview with outgoing National Institute for Health and Care Excellence chief executive Gill Leng featured a personal note when she talked about the death of her husband.

People suffering “intolerable pain” from a terminal illness should have the comfort of knowing they had “some morphine in the fridge”, said Dr Leng, whose husband, Public Health England director Sir Paul Cosford, died from lung cancer in April last year.

She told HSJ: “It is interesting to see so many different countries taking some small steps towards some sort of assisted dying. It doesn’t have to be your Dignitas model. What Paul wanted was the comfort of knowing that if it was really too awful, he had some morphine in the fridge.”

Also in our interview, Dr Leng said the “tsunami” of digital health technologies being adopted by the NHS was putting a strain on regulators’ ability to determine which ones offer value for money. She also addressed expanding NICE’s resourcing and remit.

Dr Leng is leaving NICE this spring, after two years in her role. She had been deputy NICE CEO since 2007. Samantha Roberts was appointed her successor in December.

Also on today

Dr Stephen Black on why NHS England’s plan to abolish the four-hour A&E target is a mistake, and in her regular column The Ward Round, Annabelle Collins looks at the legal headaches of mandatory vaccination.