The NHS has too many hospitals - something’s got to give
Bristol, Alder Hey, Mid Staffordshire; some hospital trusts are forever synonymous with failures which shone a light on problems found throughout the NHS. Could South London Healthcare Trust and Heatherwood and Wexham Park Hospitals Foundation Trust be about to join them?
South London is likely to close the emergency care and maternity units at its Queen Mary’s Hospital over quality concerns. Heatherwood had to seek a loan of £18m from the government, a move the Department of Health protested a little too loudly was “not a bailout”.
‘A health system cannot maintain an oversupply of hospitals - eventually, the quality or the money go south’
Both trusts have the kind of complex and extensive back story which always underpins failures like these. South London’s move appears to be connected to the tortuous and politicised debate over the shape of the capital’s health services. Heatherwood has a history of deficit, as well as disputes with commissioners and regulators. But behind the individual tales are factors that will loom large across the NHS for, at least, the next five years.
The most telling message is that a health system cannot maintain an oversupply of hospitals - eventually, the quality or the money go south. This is true during a period of plenty, which, it is worth remembering, we are still theoretically enjoying. When the money gets tight, the rivets start to pop. Rationalisation of services must be delivered in a planned way - a rash of emergency measures will produce a system as unbalanced as the one we have now. The big test will be the credibility of the savings plans being prepared by primary care trusts as part of the quality, innovation, productivity and prevention programme and due for publication in October. These projections must be very specific about, for example, reductions in bed numbers.
The other - related - signature issue raised by the events of the last week, is the speed with which the foundation trust model, as currently configured, is looking less and less aligned with policy. Can South London really be ready for full independence by March 2014 and if not, which FT would be prepared to take it on? More damaging still is Heatherwood’s loan - at highly attractive rates - which at a stroke kicks away one of the founding principles of the foundation trust movement that the government has pledged to take to fruition.
Of course, Heatherwood’s loan is not “a bailout”, just as the closures at Queen Mary’s are only “temporary” to deal with winter pressures. HSJ’s readers, however, may be forgiven for concluding that “if it walks like a duck and talks like a duck…”
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Readers' comments (8)
Joe Bloggs | 30-Sep-2010 1:20 pm
Well said.
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Anonymous | 30-Sep-2010 2:39 pm
Of course the NHS can't afford the number of healthcare providers it has. That's why it planning to increase capacity therough the Any Willing Provider model!
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Anonymous | 30-Sep-2010 3:54 pm
Spot on. The notion of any extended market with extended capacity is bizzare at this time (same goes for education).
Not only do we not need enormous amounts of additional capacity, but we also desparately need existing capacity to be reshaped and de-hospitalised ((no idea if that's a word, but you get my drift). The White Paper, sadly, is disappointingly at odds with this. It's still about processese and structures, not service models.
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Anonymous | 30-Sep-2010 7:40 pm
Finally, someone speaks the truth on this, but will it actually happen?
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Anonymous | 30-Sep-2010 8:09 pm
Its a privatisation agenda that just won't stand up to scrutiny, this lot are not just cut out for the job in hand. They will destroy the NHS on the back of their narrow minded right wing ideology.
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Anonymous | 1-Oct-2010 0:28 am
One day, hopefully in the not too distant future, there will be an honest debate about how a nation in decline is to manage the health of it's citizens (alongside how it will also educate and defend them). The model that will emerge is likely to be very different from the model we see being tinkered with today. Is there no one in this bloated, ailing health sector with the necessary intellect and leadership willing to stand up and save us all from ourselves? I sincerely hope so for our children's sakes.
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Anonymous | 5-Oct-2010 1:31 pm
Reshaping services? Closing beds and possibly hospitals? We have a legal duty to involve patients and the public about service changes and to negotiate the legal and political obstacle course and delay of 'consultation' if they constitute signficant change.
So how do we make the necessary changes happen quickly, on tiny communications budgets and teams, already under pressure? And of course the need for further management/back office savings.
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Jay Verdi | 7-Oct-2010 8:51 am
Excellent to read so many honest and insightful posts. The years i spent in NHS management we were required to be "Yes men". In any bid for revenue or capital funding we had to laud the latest policy initiatives or there was no funding. Most of these initatives were incomaptible with each other, none of them ran for long enough to flush out the consequences and/or establish the benefits. And it has been obvious to everyone in the NHS that more competition = more capacity = more whole system costs. The business of private enterprise is making a profit - so those costs will be transferred back to the govt QED (for examples see any D&TC contract)
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