Tuesday, 23 October 2012

What is happening to my hospital?

I guess lots of people around the UK are asking this question?

All around the country NHS managers and doctors are proposing to change the way services are provided in our local District General Hospitals. These much loved hospitals, with a loyal following of local people, are having the services they provide reduced or moved to another hospital.  Beds are being cut, wards being closed.

What is happening and why?

Reduction in beds and ward closures.

It is claimed modern medicine is done in different ways now compared to even 20 years ago and so there is no need for so many hospital beds. The time spent in hospital is shorter, more surgery is done as day cases and more patients are managed at home or in the community.  This means that the managers believe that hospitals mean fewer beds.

Closure of A& E Departments.

The experts from the medical  Royal Colleges tell us that A&E departments need more specialist doctors and nurses to provide a safe service 24/7.  Hospitals also have to meet the 4 hr target for waiting in A&E. So rather than employ more staff (There is a national shortage of A&E consultants anyway) the managers are merging A & E departments and closing some down.  This is happening all around the country.

Centralising services (reconfiguration and redesign).

The Royal Colleges tell us that to ensure high quality care is provided the doctors and nurses have to see enough patients to keep up their levels of skill and experience.  In many cases our local hospitals do not have enough patients so the departments are merged and moved to another hospital, perhaps in the next town. This process is called service reconfiguration or service redesign and is taking place in most hospitals across the country.

Hospital mergers.

An extreme situation is the closure of a whole hospital and merging it with a bigger hospital. This is happening in big cities.

What is happening in Buckinghamshire?

There are two district general hospital, managed as a single hospital, in Buckinghamshire, in the two big population centres, High Wycombe and Aylesbury.  Before they were merged the two hospital provided a full NHS service for inpatients and outpatients.  Since the merger there have been several proposals for change with all the associated consultations with the public. A number of services have already been moved to one site (stroke and Cardiology).  The performance of the stroke service for acute patients has improved as a result of the creation of a Hyper Acute Stroke Unit at Wycombe.

Now the mangers are implementing the next round of changes following a public consultation called 'Better Healthcare in Buckinghamshire'. http://www.buckspct.nhs.uk/bhib/

The following changes are now being implemented:
A&E consultant teams are being centralised at Stoke Mandeville Hospital (SMH), Aylesbury.
Reduce the Emergency Medical Centre at High Wycombe to a Minor Injuries and Illness Unit (The A&E was closed earlier).
Centralise specialist inpatient care for emergency medicine , respiratory, gastroenterology, medicine for older people and diabetes at SMH.
Centralise breast cancer services at Wycombe.
Transfer complex vascular surgery to Oxford but retain routine vascular surgery.

There are other service improvements planned such as a day assessment unit for elderly patients, a step down ward and admission avoidance services.

How do people feel about these changes?

Local residents in High Wycombe are concerned that they will no longer have an A&E department even though they are next to the M40 and the town has a population af about 100,000 people.
They feel that the hospital is being run down as services are centralised at Stoke Mandeville Hospital in Aylesbury (15 miles away along country roads). Following the latest consultation the PCT and the Hospital, together with the county Council, are looking at the transport infrastructure in the county, especially for those who live in the outlying villages. It seems amazing that this was done at the time the proposal was developed!  The NHS considered that transport was the responsibility of the Council and so did not address the issue at the time. The patients see things differently.

Local campaigner felt the changes were to save money and to reduce the size of the hospital. They see the changes as the thin end of the wedge leading to eventual closure.The PCT and hospital managers insisted that the changes were all about improving clinical quality.  The changes had nothing to do with reducing expenditure.

People do not believe them.

I have asked for information on how we will know that the quality of care has improved (see my earlier blog "Getting blood from a stone".  They have a 'Benefits Realisation Plan' but I think the public need something they can understand. I have a meeting soon with the hospital and I will update this blog after the meeting. 

The question that needs to be asked about all these proposals is:

Do people want a gold standard service and have to travel some distance to get it or do they want local access to a hospital and have care at a reduced quality?

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