A story of Stoke Mandeville Hospital

This is a story about my local hospital. Well, its more of a history than a story.

It is quite well known.  Famous almost.  The original hospital, built in 1940 for casualties from the war, consisted of two long corridors of pre-fabricated wooden huts. It was not meant to last long.  My father-in-law tells the story of coming out to the site as a quantity surveyor to cost a tender for building it. (They did not get the tender.) It was green field site then, outside the small market town of Aylesbury. 

Those original wooden wards stayed with us until the new PFI funded hospital was built recently.  There were miles of corridors and there had to be two 'crash teams' as it took so long to get to the wards in an emergency.

I can see the hospital from my house.  I have been a patient there and I even worked there for a while.   I was a patient on the famous wooden wards.  When I was on the local Community Health Council we campaigned for years for a new hospital.  We were pleased when the new one was built.  Little did we know of the consequences of the way it was funded.

So this is our hospital and we are proud of it.  It is Stoke Mandeville Hospital. 

You have probably heard of it. 

In 1944 Ludwig Gutttman came to work here and created a new way of treating patients with spinal injuries. An amazing man!

In 948 the first Stoke Mandeville Games were held and in 1952 they became the international games. Thus was born the Paralympic movement.

The National Spinal injuries Centre (NSIC) moved into a purpose built building in 1983.  One of the chief fundraisers for this great facility was Jimmy Savile.  This is another reason the hospital is famous as it is currently in the middle of an investigation into his activities while associated with the hospital.

The hospital has had more than its fair share of scandals. 

In 2001 the Chief Executive and Chairman resigned because the Waiting Lists were fiddled. 

In 2003 and again in 2005 it was at the centre of the hospital acquired infection outbreaks when over 30 people died in two C. Diff outbreaks.

Now, in 2013, it is one of the nine hospitals being investigated by the Department of health for high mortality rates.

Is it an unsafe hospital?  In the next blog I will write about the recent history of this famous hospital.

Healthwatch - enagaging with the public

Our band new Healthwatch Buckinghamshire recently advertised its first public meeting.

Here is part of the advert:

"Do you use any of the health and social care services in Bucks? Or do your friends or family use them?

Do you want to see them improved in some way? If so then this event is for you.

Healthwatch Bucks is the new consumer champion for our county. It will give users and communities a stronger voice to influence and challenge how health and social care services are provided in Bucks.

Come along to find out about Healthwatch, the concept, context, vision and structure. Find out about the many different ways that you could get involved. Together we can improve things – see where you fit in and how your contribution could make a difference.”   

It seems to me that the new organisation has not learnt the lessons from previous efforts to engage with the public on health care.  Public meetings do not work unless there is a specific topic of interest.  

If they want to engage with the public in a meaningful and effective way then they should hold meetings with clear objectives and achievable outcomes.  They need to think inventively and smarter.  They need to do things differently.

If they want to publicise the "concept, context, vision and structure' they could do that more effectively by circulating information by email, post or even using social media!

How about this as a topic for a meeting: What are your concerns about the high Mortality Rates at Buckinghamshire Healthcare NHS Trust? What are your experiences of being a patient at the hospitals?

That might create some interest and they could then show us how Healthwatch Buckinghamshire could influence the care provided locally and how we could provide input into the investigation.

So this is a plea to Healthwatch Buckinghamshire to do things differently. Be innovative. Be bold.

Measuring improvement in the quality of care after reconfiguration of NHS services

I asked a question at a public meeting of our local Health Overview and Scrutiny Committee. They have a slot for questions from the public.  I asked if the PCT and hospital would provide a baseline from which to measure the improvement in care promised as a result of the centralising of services on one hospital site.   

I have posted a couple of stories about the difficulty I have had in getting an answer to this relatively simple but important question:  "Like getting blood from a stone" & "What is a 'benefits realisation'?".  I finally arranged a meeting with the hospital managers who are delivering the data. It is really important to talk to the right people.

They were very helpful and, despite being busy implementing the changes, they spared an hour of their time to talk with me about how they are measuring the quality of care.  They reassured me that they have plenty of quantitative data, such as re-admission rates, length of stay, avoidable admissions and mortality rates from before the changes and they will be collecting similar data from the newly reconfigured services.   Now that is good news.

They will not be publishing the data until they have the first set of new data so that there can be a comparison made between the old and the new.   This data will be collected routinely and published regularly. More good news.

We had a discussion about how to present the results in a form that the patients and public can understand.  Not an easy problem to solve. 

We also talked about using qualitative data from the patient experience to complement the hard numbers.  Now I think that the patient experience is a really good test of quality.  The government thinks so too because the 'Friends and Family' test depends on patients feeling they had a 'good' experience in a hospital.  I am not sure that any time spent in hospital can be considered good though.  This sort of data is more difficult to get and use but we agreed that it is important as the patient can have a different perspective compared to a healthcare professional or a manager. 

The hospital has been collecting this sort of information for some years and they said that they will be using it in the baseline measure as well as in the future. 

So my question has been answered at last and I feel reasonably certain that they have the data, both quantitative and qualitative, to measure the quality of the services in some way. 

What will be more interesting is what will the patients and public make of it?  Do they care about tables and charts showing that the number of people re-admitted within 28 days has been reduced by 5%?  Will they care that 95% of patients in a recent survey said that they had a satisfactory experience in the hospital?  Will they use this data to compare the quality of different service providers? Will quality information from other providers be comparable? 

Only time will tell.

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?