Editorial - May 2003
We are indebted to Sir Alexander Macara (Sandy to most of us!) for his efforts to put together an issue covering Public Health in Bristol.
We are all familiar with the huge organisational changes that have occurred recently within the NHS. They affect all aspects of health provision including Public Health. Both Sandy Macara and Selena Gray have produced succinct and complimentary articles covering the changes. They provide information about who does what locally.
It had originally been intended that there would be half a dozen papers on Public Health matters including clinical epidemiology and research. Several months ago Sandy approached 10 people for possible contributions. In the event, despite repeated requests, Selena Gray was the only person to produce a contribution. This was disappointing to put it mildly - especially as the website is being increasingly visited and now offers an opportunity for people to air their views and provide information about what they are doing.
In attempting to put together this issue on Public Health it has become clear that people are overstretched to a degree. The ability is clearly there but the capacity is inadequate. The irony is that the opportunities have never been greater and indeed the Public Health agenda is being warmly promoted by the Government. For example, the preventative agenda is an important part of the Governments programme. The dilemma is that no one wants to be negative but the reality is that it is impossible to do all the jobs that are required to a high standard. On the other hand if the situation is not exploited Public Health medicine will not get the understanding and support from colleagues or indeed the necessary resources. A further issue is that there is ever-increasing public expectation of the NHS and this, coupled with inadequate capacity and, in some cases, threatened redundancy or redeployment, is causing yet further strains.
The editors of this website remain convinced that reliable information about the health care needs of the population is an essential prerequisite to intelligent planning of services. It is our intention to repeatedly highlight the matter in future issues of the Site.
What has happened to the hospital plan for Bristol?
Three years ago the Avon Health Authority instituted a major review of health care in Bristol. One of the objectives was to identify the possible requirement for new hospitals. Many doctors and others were involved and several comprehensive reports were produced on subjects which included trauma and emergency services, childrens services, cancer services, and palliative care. Finnamore, a firm of Management Consultants, was involved (presumably at a very considerable cost) and they produced a report in April 2002 entitled Avon Acute Services Strategic Framework Service Configuration Appraisal. Despite the dreadful title the document was thorough and based on careful research. Extensive consultations had taken place with many hundreds of people including many members of the public.
Last summer Hugh Ross was seconded from the UBHT to take the matter forward. A series of options for hospital developments were considered. These included a single site or a 2-site option. All options were placed within a framework which included:-
1. Transfer of some services from large acute hospitals into community settings including intermediate care.
2. The integration and co-location of specialist acute services
The timetable included putting 2 principal options to the public in January 2003. Public consultation was to last until early April 2003. A decision was then to be made and forwarded to the appropriate Authority and then to the Department of Health.
The plan was suddenly put on hold in December 2002 apparently because of the financial imbalance within the Avon area. Since then nothing has been heard of the reconfiguration planned.
The situation now is that Bristol is left with antiquated hospitals and no agreed plan for their replacement. In this we are unique amongst towns and cities in England.
It is likely to be at least 15 years before any new hospitals become operational.
The financial situation
The papers continue to print articles full of doom and gloom. On the 17th April the Evening Post announced that Blackberry Hill and the Bristol General hospitals could be closed to help reduce the Citys £30 million health deficit. Recently, the possibility of down-grading Frenchay hospital has been mooted.
It is hardly surprising that the public, and indeed health professionals, are totally confused. In the meanwhile the health service struggles on and patient care remains on a knife-edge even without any new cost-cutting.
The Strategic Health Authority was established a year ago. We understand that this is the organisation that has the overall responsibility for planning and monitoring. We have framed 4 specific questions for the Authority.
Questions for the Strategic Health Authority
1. Do you agree that the plans for the reconfiguring and rebuilding of Bristol hospitals/institutions should be energetically pursued? Specifically, do you agree that the current financial deficit makes the planning exercise even more urgent that it was before?
2. What is your considered view regarding the causes of the financial deficit in the Bristol area? Do you agree that antiquated hospitals, which are expensive to run, are an important factor? If you do agree are you exerting pressure on the Department of Health to increase Bristols financial allocation appropriately?
Do you consider that measures should be taken to reduce the deficit? If so what? bearing in mind that there appears to be no spare capacity.
3. How do you intend to keep the properly public informed as to what is happening and what plans there are for the next 12 months?
4. We publicly invite the Strategic Health Authority to use this website to publicise their views. We have no wish to be unhelpful or unduly critical but we are now extremely concerned at the serious situation that has arisen in Bristol.
R Langton Hewer Joint Editor.
Addendum: Since this editorial was written, North Bristol NHS Trust has announced an increase in the size of their deficit and they have set up an enquiry.