September 2003

Editorial - September 2003

Normally things are rather quiet in August. Certainly the hot weather is not conducive to constructive thought! However, as this issue of the website demonstrates - things are anything but quiet on the NHS front at present.

This issue of the site contains a further extended interview with Hugh Ross. This contains a considerable amount of information and should be of wide interest. The most exciting element is that Bristol does now have a real chance to develop a modern health service which meets the needs of the population. The concentration of specialist services and the dispersion of less specialist provision, such as intermediate care, seems sensible. I am always impressed with Hugh Ross\'s energy and grasp of the issues. As we have said before - Bristol is fortunate to have him. At the same time his task is daunting. He is working virtually alone with a single secretary and little Public Health or academic input plus an almost impossible financial backdrop.

The financial situation:

Everyone is talking about what to do. In the meanwhile the deficit rises inexorably. The causes of the deficit are not easy to determine and seem to go back into history. Although small savings may be possible - it is difficult to see how really large reductions in the deficit can be made. Presumably the SHA will produce a report on the subject shortly. Threatening noises regarding the possible closure of some of the Bristol hospitals, including Frenchay, are now appearing in the Evening Post.

There is no doubt that the difficult financial situation has been holding back the reconfiguration plans. However, the effects of this may not be entirely negative. Financial stringency is forcing a widespread evaluation of how health care in Bristol may be best provided. It is already resulting in a concentration of certain services such as vascular surgery and neonatal services. The eventual closure of some old, and totally unsuitable, hospitals may well be of benefit in the long-term. For too long there has been a lack of cooperation/planning between medical institutions/hospitals in Bristol with resultant duplication, and even triplication, of service provision which is clearly uneconomic and probably results in an inferior quality of service. In addition the lack of cooperation has resulted, until recently, in planning paralysis It is perhaps ironic that modernisation of health services in Bristol is being forced upon us by financial imperatives.

Foundation Hospitals

The pending establishment of Foundation Hospitals is being widely discussed - that is except in Bristol! For the moment our zero star rating performance precludes us for applying. Perhaps this is a good thing.

The proposal\'s central weakness appears to be that it fossilises the present pattern of major hospital distribution. The most important asset of the NHS is the skill of those delivering care. Hospitals are simply a way of efficiently aggregating skilled people and the facilities they need to do their jobs and at the same time equating population needs with the availability of skilled manpower. The present pattern of hospital service does not do this. Centres for complex conditions which need more and better teams and costly equipment, are too widely dispersed. At the same time - patients with straightforward conditions, for which most hospital visits are made, are too centralised.

Finally:

Your Editors are doing their best to collect together information about the important discussions/debates that are currently occurring. We would be pleased to hear from anyone who has got information that might be of interest to readers of the website.

Keep cool!