The need for transparency for the pressures of austerity has collided for this struggling general hospital. It has closed its A&E to all but life threatening cases, and its local MP blames management rather than clinical staff.

Rarely a day passes now without a collision between two imperatives that dictate so much of what we all do.

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In the drama at Colchester General Hospital - as elsewhere in the NHS’s week - the need for transparency has collided with the pressures of austerity in hard times.

Lives may be saved as a result, but there are costs too.

The sudden move, made last week after a Care Quality Commission inspection, to close accident and emergency to all but life threatening cases while the trust tackles safety and backlog problems was the lead story in The Guardian on Saturday.

‘The need for transparency has collided with the pressures of austerity in hard times’

But the hospital’s website reported the “avoid visiting A&E” request (endorsed by North East Essex Clinical Commissioning Group) in calmer terms alongside last week’s trust board meeting and a local Macmillan manager being honoured.

Treat yourself, ask the pharmacist for help and ring 111, the website advised patients. We can expect a lot more of this in a bad winter.

Not on top

HSJ has been covering management grief at Colchester for years.

The former capital of Roman Britain (still a garrison town) has a population of 120,000 - not much bigger than the borough of now tainted Stafford, the sort of middling town where an NHS team can easily feel pressure. But commuter Colchester has been growing lately, more like Rochester than nearby and faded Clacton where UKIP won its first seat among Colchester’s aggrieved patients.

‘The hospital has had its ups, as well as downs’

I rang Sir Bob Russell - ex-Labour then Social Democratic Party local councillor, now cheery local Lib Dem MP since 1997 - an energetic and idiosyncratic backbencher whose majority (6,982) keeps going up, not down.

He’s a reminder of why more Lib Dems will hang on next May than the polls suggest.

Sir Bob likes to be on top of things, but has not been as on top of the hospital problem as he’d hoped.

The way he tells it the hospital has had its ups, as well as downs. After the chair was forcibly removed a few years back (questions asked in parliament), it bounced back and won foundation trust status, plus plaudits.

When its mortality rates were challenged, Sir Bob and his Tory neighbour Bernard Jenkin (abroad with his committee this week) protested to Jeremy Hunt on the hospital’s behalf.

Turning the corner

The Keogh review on mortality rates left it under enhanced scrutiny, but not in special measures until a whistleblower’s revelation about cancer waiting times and allegations of altered records a year ago.

Essex police are investigating possible criminality alongside the hospital’s own inquiry.

‘Sir Bob blames poor management, not clinical staff’

But, as so often, it’s a mixed picture and many remain loyal. A woman shouted at Sir Bob on Saturday that her own cancer treatment and her husband’s experience in the stroke unit were “fantastic”.

The CQC’s latest foray (its chair David Prior is an ex-Norfolk MP himself) has shaken Sir Bob who blames poor management, not clinical staff.

“After my last meeting with the interim CEO [Lucy Moore] two weeks ago, I left under the impression the hospital had turned the corner. In view of this CQC announcement it seems we’ve not yet reached that corner,” he said before seeing Mr Hunt again this week.

Talking tariffs

The bigger picture was provided for Radio 4’s Today audience by A&E consultant Clifford Mann.

‘Most people shouldn’t be in A&E, but hospitals draft in emergency staff to cope. It costs’

Emergency care is underfunded “especially in England”, and hospitals do more electives to cross-subsidise it because the tariff is now one-third of the “not good” 2009 rate, he explained.

“Buy one and get two free.”

Most people shouldn’t be in A&E, but hospitals draft in emergency staff to cope. It costs.

“What’s a tariff?” asked the BBC’s John Humphrys. He’ll learn.

Michael White writes about politics for The Guardian