October 2003

Editorial - October 2003

Services for people with physical disability are arbitrarily divided into 3 groups based on age: children, adults aged 16-65 and people aged 65 and over. Such an age categorisation is arbitrary and subject to criticism on grounds of ageism. Nevertheless it is used throughout the NHS. In this issue we are very pleased to publish an extended article on community services for people in the 16-65 age bracket. This seems to be one of the really positive developments in Bristol Health Care.

A report on disability services in Avon was published by an ad hoc Working Group in 1988 ("The Challenge of Disability in Avon"). This report identified many deficiencies in the services currently being provided. The working group was particularly concerned that there were few proper assessment facilities for severely disabled people in their own homes. The Working Party also expressed its extreme dissatisfaction with lack of accommodation for very severely disabled people who could not return to their own homes and who were currently occupying beds in general wards.

Since the 1988 report the Bristol and District Community Health Council has produced 2 documents "Who Cares" in 1997 and "Whats Changed?" in 2001. The fact is that there have been a number of positive developments although major deficiencies remain. We are pleased to report here on the establishment of a community service for younger disabled people.

Community provision for severely disabled people aged 16-65 has improved very considerably since the establishment of the DART teams. In this issue Wendy Patterson gives a thorough and thoughtful assessment of the current position. The previously scattered services have been brought together under one umbrella and there is no doubt that the service is much better coordinated than previously.

Problems remain. Some of these are discussed in the interview with Wendy Patterson. There is a critical shortage of money. There is a particular need for improved services for head injury patients, many of whom are young, and for improved equipment provision including sophisticated wheelchairs.

Wendy Patterson does not deal in her interview with hospital provision for younger disabled people most of whom have neurological problems. Indeed, the lack of such hospital services has been a problem in Bristol for a long while (at this point your Editor declares a special interest in the subject!). The lack of medical involvement is notable and Bristol is the only major city that does not have any consultants in rehabilitation medicine. However, such a post has recently been approved and hopefully an appointment will be made shortly based on the Brain Injury Rehabilitation Unit and on the Avon Orthopaedic Centre.

Bristol Institute of Clinical Neurosciences was finally incorporated in 2000. Since then its activities have grown rapidly. We publish here some material from the latest Annual Report. Bristol has now become a really major national centre for neuroscience research incorporating not only an impressive range of activities discussed in the Institute Report but also other work including that on neuroplasticity led by Professor Collingridge and Professor Stafford Lightmans rapidly expanding unit devoted to neuro-endocrinology. We hope to cover some of these exciting developments in subsequent issues of the site.

A year ago it was "all systems go". A number of options were to be put to the public in January 2003 and final comments were due at the end of March. Thereafter the plans were to be submitted for approval. A year later we are further back then we were in the autumn of 2002. It is no wonder that the Chief Executive of the North Bristol NHS Trust services, Sonia Mills, has expressed her frustration at the lack of progress. Her comments are printed in the Evening Post of the 25^th September. She said that the condition of buildings is a major issue. She also sited lack of progress in the reconfiguration of services across Bristol as something which contributed to the Trusts difficulties. Site reconfigurations have been reviewed from time to time with no result.

It seems that the public consultation exercise will now begin in the late autumn and will run through until next summer. At this point a number of options will be presented including moving all services to Southmead or Frenchay, moving services to one site and keeping minor services going at the other site or opening a brand new hospital on a green fields site. Other options are possible..

In the meanwhile the City struggles on with its antiquated hospitals and there are continual mumblings about hospital closures but no comprehensive plan for their replacement.

Bristol has not been well-served by its planners over the last 15 and more years. Why did the Regional Health Authority and Avon Health not produce and push through plans for the redevelopment of Bristol hospitals? Why was there so little cooperation from the various organizations involved? Presumably no one ever will be held accountable.

As we go to print the report on the financial problems that have engulfed the North Bristol Trust has been published. It makes sorry reading. The principal findings are on the website of the SHA (www.agwsha.nhs.uk.). From the professional point of view the important issue is still " How is the reconfiguration project to be pushed forward without yet further delay?" The patients perspective is the same although differently phrased" when shall we have modern hospitals that provide safe pleasant and effective care?". The financial crisis must not be allowed to further derail the reconfiguration exercise. We invite the SHA to give their considered views and would be pleased to publish their response

R Langton Hewer (Joint Editor)