Published: 07/10/2004, Volume II4, No. 5926 Page 16 17
Uttlesford in Essex has the best quality of life in England, according to a Sunday Times survey. But Essex is a county of extremes and also there are pockets of high deprivation in Harlow, Basildon and along the southern coastline.
However, NHS trusts in Essex believe they are on the up, and according to the county's strategic health authority chief executive Terry Hanafin, the aim is for all the trusts in the region to achieve 'universal excellence'.
'When I started here some of the services were really poor as a result of several years of underinvestment. I was shocked at some of the physical facilities and at the state of some of the acute hospitals, which had not had any major investment for several years.'
One of the historical problems has been the SHA's close proximity to London, which Mr Hanafin says tends to suck money away from local acute services and into the big London teaching hospitals.
This year's local delivery plan for Essex is centred on three core areas of work: reforming emergency care, developing 'tier two' primary care services, and investing heavily in the management of patients with chronic disease.
Across the health economy there has been notable progress this year - seven trusts moved up a star and 17 of the area's 21 trusts are now two or three starred.
One of the high flyers is Essex Ambulance Service trust, which under the leadership of chief executive Anthony Marsh gained three-star status this year after being zero starred in 2003.
Mr Marsh places particular emphasis on the trust's role in reforming the emergency care agenda: 'We do not believe, for example, that the four-hour accident and emergency waiting-time target is just for acute trusts, it is being led by them but it should be seen as a target for the NHS across Essex, ' he says.
Reshaping acute services to become 'very good district general hospitals' is an integral part of the plan to achieve excellence, according to Mr Hanafin.
'We want them to serve their population really well and be doing the type of work they should be doing.'
This includes reshaping services so that much of the outpatient and elective surgery which is currently done in the acute setting is transferred to more appropriate centres. This plan is most advanced on the county's south coast, where Southend Hospital trust along with Southend and Castle Point and Rochford primary care trusts are leading on a new independent sector treatment centre project with Anglo-Canadian.
When up and running in February 2006, it will be one of the biggest stand-alone centres in England, treating 16,000 outpatients, mainly in day-case elective surgery over the next five years.
Southend PCT chief executive Julie Garbutt says that the new centre is crucial to meeting waiting times in south-east Essex, and adds that the health economy 'cannot do that in its current form'.
But the health economy does seem to be getting on board with some key areas of national policy.
It already has one first-wave foundation trust at Basildon and Thurrock, and Southend hospital trust - having been three-starred for the last two years - has recently made an application for foundation-trust status.
Dr Patrick Geoghagan, chief executive of South Essex Partnership trust, which is also three-starred, says his trust will be one of the first to express an interest in becoming a mental health foundation trust, although under current proposals this will not become a reality until April 2006.
One area of concern for the region over the next few years is the size and capability of the 13 PCTs to deliver the national agenda. Mr Hanafin says that the area's PCTs are smaller than the national average, serving populations as small as 70,000.
'We are concerned that they may be too small to deliver the agenda and we are trying to get them to work together where appropriate.
'We are having a really big push on this, especially in the area of acute commissioning, because we do not think that [PCTs] have got the capacity to do this unless they share the work, ' says Mr Hanafin.
Julie Garbutt agrees. 'We have to look at all the opportunities for joint working, not only with other PCTs but with the local authority and social services'.
She says that Southend PCT is in a fortunate position because it is coterminus with Southend-onSea borough council and already has a joint integrated directorate for adult services with a lead who is jointly sponsored by both.
However, Ms Garbutt cautions that a debate is needed on whether, if PCTs are encouraged to work much more closely, they must ensure that they 'preserve [their] local nature and still have local boards and professional executive committees'. However, she concedes that 'to manage the agenda we have to be bigger'.
Last month, Witham, Braintree and Halstead care trust chief executive Dr Paul Zollinger-Read became joint chief executive of Chelmsford PCT, the only PCT across the region to be zero-starred this year. 'This is a permanent arrangement, ' says Mr Hanafin. 'A new structure is being set up between the two trusts with a new board we will move to merge the two when legislation allows.'
Dr Zollinger-Read says he believes the joint arrangements are a positive step, and the hope is that not only will the Chelmsford PCT improve its performance next but that the two will have the extra capacity to meet the increased commissioning agenda.
There seems to be a buzz in Essex. And although not everything is rosy, things are looking up. As Dr Geoghagan says: 'Watch this space.'