Interview with Hugh Ross on 25th June 2003

This is the third time that Hugh Ross has kindly agreed to be interviewed. In October he was optimistic about the Bristol Services Plan. There was debate as to the number and sitings of acute hospitals in this City. A decision as to which options to put to the public was imminent. Public consultation was to start in January 2003 and would run through until Easter 2003.

The second interview occurred in January 2003 and by that time the situation had changed. The development plans had been partly put on hold because of the increasing financial deficit. Nonetheless, Hugh Ross hoped to make progress on long-term plans later in 2003.

HR said that the Lift Programme was rolling along with an expansion of primary care facilities. The plans for the replacement of Barrow at Callington Road in South Bristol were proceeding. There were other mental health developments. There was now a greater appreciation of the need for cross-city working. This included the move towards single clinical teams throughout the City. In addition there was a move to concentrate certain services on one site - e.g. maxillo-facial surgery. All this was consistent with the long-term plan for a unified health service throughout Bristol.

HR reported that there is a Clinical Planning Group (CPG) on which both senior hospital and primary care staff are represented as are the Chief Executives of those groups. Each group is reviewing the work undertaken in the Finnamore and Sigma Reports. There is much discussion about the number of hospital sites and the new Diagnostic and Treatment Centres. The triple issues of resources, capacity and affordability were in the forefront of everyone's minds.

On the negative side - the financial situation is now recognised as being far worse than it was 6 months ago - partly because of the news that North Bristol has a deficit of £44 million pounds. This is complicating the planning process.

The Finnamore Report dealt mainly with the acute hospitals issue. The Sigma report dealt with community hospitals. I first asked HR whether these 2 reports, together with the supporting documents, could/should be made widely available to the public. The latter contained valuable material on such issues as childrens services and A and E. He replied that he was uncertain as to what had been agreed about the matter and would let me know.

HR stated that the Primary Care Trusts would be leading a series of meetings in the coming months. The Bristol Health Services Plan Website is now being updated regularly (www.avon.nhs.uk/bhsp/)

We need to go through a detailed process of public consultation. However, there are difficulties here. One problem is that the Community Health Council (CHC) is due to be abolished in December 2003. They have given us good advice. After December there is likely to be a bit of a vacuum because the New Patients' Forums will just be starting up and it is not entirely clear how they are going to work in terms of consultation and so on. In essence - we are trying to make substantial changes in health care provision in a more complicated climate of public consultation than has existed in the past.

HR stated that it was intended to have a draft plan for the reconfiguration of health services in Bristol available by September 2003. The intention is to get this tested with the Department of Health. Once their approval has been given to the broad strategy - the plans will need to be worked through in detail.

HR stated that we need to get on and try to get an investment plan agreed. Even if it is agreed - it will be many years before the developments will come about because of many different hurdles including particularly finance. We are already 10-15 years behind where we should be because of decisions that were not made back in the 1980s and should have been made then. HR emphasised that unless there is some compromise and unless people are prepared to adopt a pragmatic approach - the plan could be delayed indefinitely. We must not let this happen.

HR indicated that the key requirement is that any plans will be affordable in the long-term - say 10 years ahead. The Finnamore and Sigma Reports did not deal with this issue in detail although they did cover the comparative costs of the different options. HR emphasised that the planning exercise has been made more difficulty by the deteriorating financial situation of the health community in Bristol.

HR emphasised that any plan must encompass the whole of the Bristol clinical area. Trusts are no longer free to \"go it alone\" regardless of what other organisations are planning. In any event - any developments in the acute sector will be funded partly by the Primary Care Trusts. The jargon phrase for the present philosophy of planning is - \"A whole system's approach\".

HR indicated that the possibility of closing some of the old expensive hospital sites is being considered. This should free-up some money which can be reinvested for the future.

HR first dealt with the Bristol General Hospital (BGH) which was opened in 1858. Although the standard of care there is very good and the staff very committed - it is clearly not a building that is suited for the modern purposes for which it is now being used. The UBHT has always planned to take the hospital out of use. Now the South and West PCT would like to see some of the services relocated in South Bristol into a new community hospital.

Similarly the North Bristol Trust are looking at the possibility of removing general medical services from Blackberry Hill Hospital. They are liasing with their related Primary Care Trusts. Bristol North PCT think that they can reduce acute admissions by about 20% in the coming years. If that is true - it should be possible to downsize our main hospitals in favour of more locally-based intermediate facilities and indeed more advanced home care.

HR pointed out that the BRI has recently put in place 2 fabricated wards. A similar exercise could occur elsewhere - for example the provision of 2-3 prefabricated wards on the Frenchay site to replace some of the beds at Blackberry Hill.

The PCTs are also looking at Yate, Thornbury, Keynsham, and Clevedon.

HR stated that he was keen to explore in more detail some of the options and their cost implications.

The cheapest option for Bristol would be to put everything, community-based services and all, into one huge hospital. The most expensive option of all is to continue with 3 main hospital sites and have community hospitals as well. Our dilemma, of course, is that the public would like to be in the \"let's have everything everywhere\" bracket to a large extent.

The PCTs would like us to be moving toward new community hospitals and less main acute hospitals. The hospital clinical staff would like fewer acute hospitals but some are less concerned about the community issue.

The financial imperatives take us away from more hospitals and more community hospitals to less. We thus have a whole series of competing tensions. We have to work out what capacity is required and then to come up with a whole system's plans which is, a) clinically coherent, b) acceptable to the public broadly speaking and c) is affordable. Achieving these objectives is quite a challenge!

As far as hospitals are concerned - there seems to be general agreement that we shall end up with 2 acute hospitals. The debate now comes down to 2 choices. The first is that we put all the specialist services on one site and the other site is effectively a DGH. The second involves an acceptance that there will continue to be specialist services on both sites. HR states that his pragmatic judgement is that we are more likely to make quick progress if we accept that there will continue to be specialist services on both sites.

Hugh stated that it seems to him that whatever savings are put in place - it will not be possible to get where we need to be without substantial new investment. The question then arises as to how the new capital investment can be supported in revenue terms.

It is essential that we get all this right because it will be one of the biggest investments programmes in the NHS.

Richard thanked Hugh Ross for his time and patience and we agreed to meet again some time in the Autumn.