Parochial, insular and out of date - and these are some of the nicer things Worcestershire health authority chief executive Pat Archer- Jones says about those campaigning against the downgrading of Kidderminster General Hospital.
Her opponents, the Save Kidderminster Hospital Campaign, have scored a stunning victory in the local elections. Candidates running for the council under a Health Concern banner won 11 seats in three town halls after five weeks of campaigning.
This unprecedented success for single-issue candidates meant the sitting Labour administration was deposed from Wyre Forest district council. Seven campaigners now hold the balance of power there. Four others sit on nearby Bridgnorth and South Shropshire councils.
The election result doesn't give the councillors any power over the HA. But it has certainly made NHS chief executive Sir Alan Langlands sit up and pay attention.
An example of 'active citizenry' was how he described it at the Institute of Health Services Management's annual conference last month.
The councillors themselves 'will never forget that evening' they were elected, according to Brian Glass, whose result was the first to be announced.
He says their election, on a relatively high 37 per cent turnout, 'sends a message about the arrogance' of both elected and unelected decision makers - to Labour, in both national and local government, and to the HA.
It's not all good news for the protesters, though. Critics say the victory has put council business in chaos, with no chairs of committees decided.
Ms Archer-Jones says 'the bulldozers are in place' and work on the private finance initiative hospital is going on regardless. And there is little chance of reconciliation between the HA and the councillors.
Wyre Forest officers were writing to the HA last week to ask for talks and observer status on the HA and the project implementation group. But Ms Archer-Jones is not impressed and feels that Kidderminster is a 'very insular community' with plenty of retired people with time to run an effective campaign, backed by money from local businesses.
The campaigners 'are clinging on to an image that has gone' of old-fashioned local hospitals, she adds.
Unsurprisingly, all this means the HA chief executive is not keen to embrace partnership. 'They have made it very clear that they don't want to work with us to implement the changes. Their sole motivation is to wreck them,' she says.
As Ms Archer-Jones points out, Worcestershire HA's strategic plan for the next five years has survived analysis by the King's Fund, Kidderminster and District community health council's application for judicial review (which was rejected) and referral to health secretary Frank Dobson.
The plan, optimistically entitled Investing in Excellence, was launched in February last year. The five-year strategy gave Worcester a£116m new hospital, to be built under PFI.
What outraged the campaigners was the decision to concentrate major trauma and acute specialties such as vascular surgery and urology on the PFI site, 18 miles from Kidderminster.
According to the plan, Alexandra Hospital in Redditch would 'continue to treat a comprehensive range of medical and surgical emergencies from its local population', but not severe trauma.
Kidderminster Hospital trust would be reduced to running an 'ambulatory care centre' offering 'a wide range of diagnostic and treatment services'. Patients could get day surgery and outpatient treatment but would have to travel for inpatient medical or surgical attention.
The HA says the changes, which include merging Worcestershire's three acute trusts into one, would save£1.5m - enough to make a Continued from page 9
sizeable dent in its recurring£9m deficit.
Ms Archer-Jones claims the review of services 'wasn't related to finance' but to clinical safety. Kidderminster General Hospital was based on a team of general surgeons, with one vascular surgeon, which 'was not sustainable'.
The plan says concentrating acute care at the new hospital in Worcester will ensure 'much better care at a specialist centre serving the whole county'.
Councillor Jane Paterson, night co-ordinator at the hospital, does not agree. 'We are talking about a removal of the health service from Kidderminster.
'More than 100,000 people live within 10 miles of the hospital,' she says. 'At the moment it takes only five minutes for people to get to Kidderminster, where you have a doctor on site ready to do anything that is required.'
Following Mr Dobson's intervention, the hospital will retain an 'emergency centre' capable of treating about half the patients who currently use A&E and staffed by nurses with a part-time consultant.
That is not enough to satisfy Ms Paterson, who says traffic congestion will make the journey to Worcester for most acute services long and difficult.
Her opponents claim the councillors are difficult. Labour group leader Jamie Shaw accuses Health Concern of holding up council business and creating bureaucracy by failing to elect committee chairs and failing to send substitutes when its members are absent from committee meetings.
With Labour unable to form a minority administration, the protesters now hold the balance of power on the council, where they form the second- largest party.
'The police, the chamber of commerce and the employers are voicing their concern, as are council officers privately,' says Mr Shaw.
'We need to have a political figurehead to refer to when there are problems, and it makes things difficult when all there is are spokesmen. If there are important decisions there would have to be a special meeting of the committee with all the delay and cost that implies.'
Ms Paterson replies: 'I haven't seen any sign of council business being held up. If it was we would be doing something about it'.
She admits there are no committee chairs yet, so the councillors elect a temporary chair every time they meet. But there has only been one meeting of each committee so far, she adds.
Health Concern councillors claim their lack of experience of local politics is a plus. Madge Shineton, who sits on South Shropshire council, says they have 'no party political baggage'.
Their backgrounds, as a teacher, a nurse, a retired sergeant major, and the owner of a dry-cleaning business, give them a variety of useful skills, she says. 'If you can run a small business you can sit on the council.
'We stood on a single issue, but once we became councillors we have to represent our wards on all issues. It wouldn't have been fair on the electorate if we weren't prepared to do that.'
Dr Richard Taylor, chair of the Save Kidderminster Hospital Campaign, says the group will spend the next four years 'monitoring the changes as they are introduced'.
The councillors also intend to bring a 'health focus' to all policy areas, from the environment to parks and gardens.
Back at the HA, Ms Archer-Jones says she is going to stick around to see her plans implemented. She is keen to pick up the management savings identified by the project group leading the trust merger and insists the£1.5m savings target from the changes will be achieved, partly by 'selling off redundant buildings' at Kidderminster.
And she is bullish about the impact of this high-profile row on her own record. She says: 'I would like to think this has done my career some good. I have grown from the experience and it has developed my management skills. I haven't just survived, I have achieved something.'
Ms Archer-Jones may regret nothing. But would the campaigners do it all again in 2003, the next time these seats come up?
Dr Taylor says they haven't thought that far ahead. 'But we are certainly talking about putting up candidates for the seats that are contested next year'.