Further Interview with Hugh Ross at
King Square House - Tuesday 21st January 2003
I last interviewed Hugh Ross, in his role as Programme Director of the Bristol Health Services plan, on the 16th October 2002. At that time there were plans for improving community facilities. In the previous two years there had also been discussions regarding the rebuilding of the various hospitals in Bristol and it was intended to present the options to the public starting in January 2003. There had been much discussion as to whether there would be one single major acute hospital in Bristol or whether there would be 2 or even 3 such hospitals. The Chairs and Chief Executives of the local NHS bodies then subsequently called a halt, which will hopefully be temporary, to the major consultation exercise which had previously been discussed. It was apparently considered that the financial deficit that has been incurred locally must be addressed first before engagement and consultation takes place. Hugh Ross was at pains to point out that the development of some local community facilities will, hopefully, proceed and that long-term planning is continuing.
The financial deficit
It appears that the total deficit having been run up by the 25 different organisations covered by the Strategic Health Authority is approaching £100 million. This equates to something like 5-6% of the total annual NHS budget in the Strategic Health Authority area. The total expenditure of the Strategic Health Authority annually is between 1.5 and 2 billion pounds. The deficit therefore represents about 5% of the total NHS annual budget for this area.
It seems that a proportion of the deficit was incurred prior to April 2002 when Avon Health was in existence. The deficit has been incurred widely by both Acute Trusts and by the Primary Care Trusts. It appears that the Primary Care Trusts inherited a deficit from before they were set up! The areas that have incurred the maximum deficit are Bristol, North Somerset, and South Gloucestershire. A considerable deficit has been incurred by the Royal United Hospital, Bath.
It is not easy to ascertain why the overspend has occurred at a time when other parts of the country have been able to operate within the allocated budget. Hugh Rosss view is that much of the problem was due to lack of financial planning in the 1990s. However, there are other factors which include the rapidly increasing workload, the high cost of agency nursing and the increasing cost of medications. For example, an increasing number of patients are being put on to statins which are expensive. The situation is complex. The expectations of the public are increasing and strict government targets have to be achieved. All this costs money. A further problem is that some of our buildings are old and cost more to run than modern facilities. There is a major lack of capacity. Because of this an increasing amount of work is being done for the NHS in the Private Sector and this, again, costs money. The Government makes no allowance for this when considering the health allocation to different parts of the country. This is determined by the demography of the population e.g. age, social structure, etc.
The Bristol share of the £100 million pound deficit is about £50 million pounds. The Government requires that a 3/4 year plan be drawn-up some that the deficit can be eliminated at the end of this time. This will mean paying back the overspend and cutting back on current expenditure.
It is understood that discussions are currently taking place with the various relevant authorities prior to the drawing up of a plan to reduce the deficit. At the moment no clear areas for financial saving have been finally agreed. Hugh was keen to emphasise that extra money is coming in to improve the service. However some of this money will need to be spent on the purposes for which it was allocated and will not necessarily help remedy the over-spend.
The reconfiguration project
Hugh stated that work is continuing on the Bristol Health Services Plan but at a slower pace than before. It is hoped to be able to turn to the longer term agenda towards the end of 2003. It was important to ensure that the long-term plan be kept in mind and not deferred for too long. This does however mean that there will be no major rebuilding of the Bristol hospitals during the foreseeable future. However some modest improvements may occur and Hugh indicated that a further 60 beds are being provided at the Bristol Royal Infirmary by the installing of two prefabricated wards
Other developments
Hugh spoke enthusiastically about the new diagnostic and treatment centres (DTCs) that are to be established at Cossham Hospital and in Hengrove. These will not contain beds. However it will be possible to undertake minor surgery in these units. There will be important investigative facilities including probably CT and MRI. Twenty to 24 such units are planned within the country but none have yet been opened. Critically though, resources still need to be identified locally for the extra work this entails.
The LIFT project
The objective of this project is to improve the estate in primary care i.e. mainly health centres.
The development of City-wide services
Hugh is very much in favour of the development of City-wide services i.e. services that cross Trust boundaries. This has already occurred, to some extent, in vascular surgery and there is possibility of it being developed in other surgical specialities.
Finally, Hugh was upbeat about the position. He agreed that it was disappointing that public consultation has had to be put into abeyance for the moment. I thanked him for his time and we agreed to meet again when appropriate.
Richard Langton-Hewer
(Joint Editor).