2nd. EDITORIAL
New hospitals for Bristol?
There is no ideal time to plan a hospital! Yes, but Bristol hospitals are in such a poor physical state that something must be done soon. One of the difficulties is that the organisation of the NHS is in a state of flux and this, plus rapid developments in medicine and health care delivery pose considerable difficulties. On the other hand, the Government has embarked upon a large hospital rebuilding programme and it is essential that Bristol is included in this. Our hospitals are old and in urgent need of replacement.
During the last two years there has been a major exercise in Bristol to identify the issues and to come up with an agreed plan to put to the Government. This has taken place within the Avon Acute Services Strategic Framework (AASSF). A firm of management consultants (Finnemores) has been closely involved. The discussions have occurred largely in private although there has been some public consultation. Snippets of information have from time to time appeared in the Evening Post but most people do not really know what is going on. Paul Abrams proposal for a single hospital appeared on his website a year ago and received much support from doctors.
There has also been concern that Bristol would never be able to agree on a hospital plan. The building of the new Childrens Hospital by the UBHT, apparently without the full agreement of the other acute Trust or of Avon Health, was a surprise. The subsequent production of a report on childrens services which recommended that all paediatric surgical inpatient beds should be on one site led to the conclusion that the Childrens Hospital was too small and there was speculation in the Evening Post that the hospital might need to be rebuilt elsewhere! This episode undoubtedly dented confidence in the ability of planners to act on a concerted Bristol-wide basis.
However, happily things have moved on. Recently the Bristol Health Service Reconfiguration Project has been established with Hugh Ross as its Director. Hugh is keen to let everyone know that he approaches the matter with an independent mind and that his previous close association with the UBHT will not influence him one way or another. Bristol is fortunate to have such an able person available for such a challenging task. Hugh will hopefully be contributing to the next issue of the Med-Chi newsletter.
The first issue appears to be whether there should be one or more acute hospitals in the City. A second concerns where any new hospital(s) might be built. A central difficulty here concerns the use that might be made of the BRI complex and whether there is any way in which it could ever be the site for a single major hospital encompassing all the major specialities.
A further difficulty is that the two acute Trusts in Bristol have been separately producing plans for hospital development. These have appeared in the press causing further public uncertainty. (Surely, the time has come for Bristol to have one single acute Trust!)
All options involve the transfer of some services and resources from large hospitals into community settings. Patients in the intermediate care group would not, in general, be looked after in the acute setting .
The location of casualty departments is probably the issue that most concerns the public. The AASSF undertook a detailed review of the matter. It seems that 42% of a typical A&E workload is accounted for by minor injuries. The review recommended that there should be an integrated trauma network for Avon. There would be four A&E departments (Bath, Weston and two in Bristol) which would work from the hub of a service network linked with minor injury units. This means that some aspects of current A&E service would be provided at a more local level. The group did not recommend, on the basis of A&E considerations alone, centralising all services for the severely injured on one site in Avon. However, each A&E Department that receives severely injured patients must have appropriate 24 hour cover. The difficulty of obtaining input from trauma, orthopaedics, paediatrics, general medicine, general surgery, ENT, neurosciences, and vascular and plastic surgery was noted! This is an excellent review and hopefully will be available for general perusal at sometime in the near future.
The review of hospital services for children was made available in June 2001. This recommended that hospital services for children should be planned, commissioned, and managed as a single service. There would be a number of extended Day Care Option Units in four locations in Avon for children who are acutely ill but do not require complex interventions. The idea is to prevent admission to hospital if possible. All specialist tertiary childrens surgery in Avon should be carried out at a single Childrens Hospital with on-site access to the Regional Paediatric Intensive Care Unit. The current provision at Frenchay was considered to be unsatisfactory.
The single site hospital option, or a variant of it, is favoured by most consultants in acute specialities. However it is not supported by the local councils. The views of the primary care Trusts are not yet known. There are concerns about managerial complexity of a single site hospital, ease of access, the risk of terrorist attack and the effects of an outbreak of severe infection.
A note of caution. Although a vast amount of data is available there is little analysis of what hospitals in Bristol, or elsewhere are actually being used for. It is particularly noteworthy that the needs of patients in hospital are not analysed in any systematic way. Documents tend to concentrate instead on "activity" rather than "need". Surely this is wrong hospitals are supposed to exist mainly for patients! An article in the Bristol Medical Journal summarised the situation neatly.
"A close observer of the NHS over the past ten years might be forgiven for thinking that the debate about the concentration of acute hospital services has been driven more by the needs of NHS managers and the medical professions than by the needs of the local populations that they are supposed to serve."
Overall, one can be pleased with what the Planning Group, and others, have achieved during the last two years. Hopefully the results of their deliberations will be made public before too long. There is no doubt that the next 12 months will be critical. Bristol is fast approaching decision time.
Reference:
(Posnett, J. The hospital of the future is bigger better? British Medical Journal 1999; 319; 1063)
R Langton Hewer