4.Views & Editorials

Letters/Comments on Bristol Healthcare

Subject: Future of Bristol Healthcare

I have looked at your website and have a few thoughts.

Firstly you, as a society, do not need to be constrained by "political considerations", that is by what is considered "politically achievable". Indeed, if you do feel so constrained, you will be prevented from informing the discussion. I am sorry I am unable to be with you.

1. I believe a blank sheet of paper is the proper starting point. How should the primary and secondary care facilities be configured to be fit for purpose in the 21st century? Add to that an increasing pressure to provide more and more tertiary services?

2. How will the effect of the European Working Time Directive, consultant contract, increased sub-specialisation and likely recruitment (for all types of staff) impact on any model of health care?

3. What are the likely demographic changes in our society and what will be the effects of new treatment technologies, disease prevention and better clinic disease management?

4. What do services look like today and how far can they be adapted to give the ideal, as described by the "blank sheet" exercise?

In your text under "The major hospitals" item 3 "It has been decided ........" That decision was made against almost all clinical advice. If your meeting seeks to achieve discussion rather than receive information, then that decision should be recognised as an administrative decision taken for political expediency and questioned.

The clinical advice was: rapid expansion of primary care facilities an integrated secondary/tertiary care plan for the whole of Bristol a probable two site model with : - a complex and emergncy centre - a second site to deal with "simple elective surgery", investigations and rehabilitation a single trust to administer the hospital sector

This plan might have appeared somewhat revolutionary when we discussed it, but is the way in which secondary/tertiary care is becoming organised in most cities in the UK of a similar size to Bristol.

The decision to have two similar sized hospitals administered by two different trusts is against the wishes of most clinicians and is unlikely to lead to the best model of patient care and will be shown to be unnecessarily costly and quite possibly unworkable.

Very recently, Phil Yates, chair of the S Glos PEC, gave a fascinating talk about the future of primary care, envisaging the transfer of many services from secondary to primary care in the next ten years. This has not been adequately considered and should have a fundamental effect on planning.

Yours sincerely

Paul Abrams

Professor of Urology, Bristol Urological Institute

Southmead Hospital, Bristol BS10 5NB

tel: +44 117 959 5690 - fax: +44 117 950 2229

March 19, 2004

30th March 2004

1. Has any attention been given to the steadily clogging up of Bristol as illustrated by the snowy Thursday of a few weeks ago? A single hospital may be inaccessible under certain conditions e.g. a terrorist attack.

2. Will not specialists find their job getting progressively more boring?

3. I am sorry that three A & E departments are considered too many. With excessive waiting times at present (before I got fed up and went home a few weeks ago, I waited 2½ hours in the BRI), these will surely increase with reduced numbers at centres. Ambulances should share casualties according to pressure (see note 1.)

Yours sincerely

Dr Norman Cook

31st March 2004

To: Professor Richard Langton Hewer and Dr Michael Whitfield

Thank you for organising yesterday’s meeting. Amazing that no one delineated what is wrong at present!

What we may need is ONE SERVICE throughout the patch and community hospitals/centres within a year or two.

I think the delineation of the future one or more giant high tech hospitals might sort itself out once the community and services are in place.

I agree that psychopathology affecting consultants is behind much of our problems but Bristol is not alone in this!

If I can be any help in forming a working pressure group to encourage the younger to work together, do please let me know.

With many thanks

Yours sincerely

Dr Christopher Burns Cox

Gloucestershire

‘The Future of Bristol Healthcare’ – Med-Chi & BMA meeting 30.3.04

Observations and Reflections from the back row!

First, thanks to Prof Langton Hewer, Sir Sandy Macara and Dr Whitfield for the vision and work of convening the meeting, which seemed to me of great value, and a potential paradigm for a forum for the necessary process of change. May I make the following points?

• The lack of local leadership is obvious, and a central issue needing resolution. Bristol is stuck with three hospital NHS trusts, and this militates against the co-operation needed for a single strategic vision. Equally obvious, is that the Strategic Health Authority has no intention of putting the leadership in from outside – the reaction to Prof Alderson’s invitation on this point was clear. Leadership has to emerge before the process can get underway – preferably leadership trusted by a critical mass of that part of the local medical body that sees itself as having a stake in the future. In Great Zimbabwe, in the years of its power, decisions were taken by talking and talking again until a consensus was reached. Whilst I understand there isn’t the time for this, there is an aspect of the recognition of the importance of ownership of a process, that needs to be valued. Perhaps leadership could emerge from within the process of a forum resulting from last night’s meeting?

• Dr Will Warin’s vision for the future. I have no quarrel with the vision – clearly, all the points he makes about how much care can take place in the community, to the benefit of the patient, are right – none of it is beyond the ability of primary health care teams. However, those of us heavily involved ‘at the coal face’ recognise that the shift in care cannot take place without a concurrent shift in human resources from the hospital to the primary care sector. Our consultant colleagues are unfamiliar with a model where GP’s are directors of our own small business, and function as consultants and housemen in the workforce, and all stations between. The new GP contract requires us, rightly, to move our medical practice to proactive, population-based preventive care, instead of reactive treatment of those who come through the door. No additional manpower follows the requirement – we work smarter. But ask the workforce to follow Dr Warin’s vision, without increased human resource, and the profession will tell you it can’t be done – we’re too busy already.

• There is a demographic time bomb lying in wait for general practice. Currently, in the South West Region, two GP’s have to be trained to produce one full time GP. Increasingly, the intake to medical schools is female. Women tend to opt for general practice, and work part time. It may be that the human resource to maintain even the status quo will be a problem in years to come.

• Increasingly, primary care is becoming the forum where medical students and young doctors will receive a large part of their training – the new clinical academies illustrate this point. Patients spend less time in hospital, and students need to come to the community to find their experience. Primary care will need to accommodate young doctors in their F1 and F2 years, as a result of ‘Modernising Medial Careers’, and increasing numbers of GP Registrars will need to be trained to maintain the status quo. So teaching will present a big agenda to primary care, competing with any attempt to shift clinical care across to the community. It can’t be done without the human resource.

Well, I must say, again, how valuable last night’s meeting seemed to be – a real opportunity at last to hear what’s going on, and exchange ideas. Thank you.

Dr Joy Main

General Practitioner and Undergraduate GP Teacher

Hartcliffe Health Centre

31.3.04

30th March 2004

Hi,

I’m a 3rd year medical student. As some of the changes that you are discussing are due to occur in the next 3 – 5 years it would be helpful if this was also discussed and debated at our level, especially in light of the extended two year Foundation scheme where we will be hit (as junior doctors) and affected by all this.

Miss Shairoz Sanji

ss0746@bristol.ac.uk