Monday, 22 February 2010

The Debate on Kingston Hospital

Britain is skint! That was, recently, the forceful reminder of Marks and Sparks’ top performer, Sir Michael Rose! Ireland with a 12% budget deficit - the same as Britain’s - is cutting back public sector pay by 5% for the lowest paid, rising to 20% for the Prime Minister. That sets the scale of the problem. Repeating this year’s Government borrowing of £3,000 per head - for future generations to repay - does not! Nor can the NHS be excused from sharing in the need for more effective use of constrained resources.

While, therefore, every support has to be offered the “Big Health Debate” announced by NHS Richmond at its January Board, the future is not set fair. Too much is being reviewed too precipitately made worse by Whitehall calling this initiative “world-class commissioning.”

The news (R and T Feb 12) on Kingston Hospital and the possible closure of its accident and emergency (A&E) services and of its maternity services, shows NHS planning at its worst. Enormous resources have been concentrated on turning it into a Foundation Trust A&E Hospital only for the whole enterprise now to be questioned.

Leaked documents are no way to start the Big Health Debate, but they can be helpful. Too much consequence has and is being applied to the “clinical strategy group” that has no authority to “rule out” certain options unless it has been instructed to do so. Was it so instructed, and if so, by the SHA or by the joint PCTs of SW London? The full brief to which this group has been working can and must be made public.

Kingston is one of three hospitals in the SW London sector that provide a “midwife-led and a doctor-led unit on the same site”, the lead priority for mothers. Maternity services with a consultant present is no doubt desirable, but to plan for such care “around the clock” - or for 168 hours per week when current performance is less than 98 hours - is clearly not realistic, given the financial constraints.

As with maternity services, so elsewhere. All credit must be given the clinical group for starting off the process, but NHS Richmond’s full review of the options must be more cost-conscious, more patient-centred and with a more balanced perspective from its clinicians. Let Richmond get one polysystem up and running and see the saving effect this has on hospital costs before more extravagant measures are considered.

NHS Richmond has many strengths, not least its consistency in keeping within budget; but is not this strength, in its commissioning, only won at the expense of budget weakness amongst its NHS providers - a question that was glaringly omitted from Professor Darzi’s “Healthcare for London”. In its January agenda, the PCT divided its £210.8m budget into commissioning, £149.8m secondary and £40.9m primary, leaving £20m for what it calls “corporate”. Only a minor portion of this £20m is for front line services; the review needs to give it greater attention.

Another of Richmond’s strengths is its strength as a team led by chair Sian Bates, fully recognised in her role as chairwoman of NHS SW London. No one is more experienced in reconciling - with the support of her non-executive directors - health needs as perceived locally with strategic policies laid down by the Health Secretary.

Sadly, however this local perspective is not voiced strongly enough, aggravated by the Council finding it “inappropriate to question national considerations.’ If the statutory won’t, then the voluntary sector must, that all are agreed is an “essential component in a democratic society” (Compact). If NHS Richmond calls on numerous and costly management consultants to clarify its intentions then there is a strong case for its local partners to do likewise - by the CVS, for instance, commissioning Lord Crisp, the former Chief Executive of the NHS, to provide his far more pertinent advice at comparatively minimal cost.

Yours sincerely

Francis King

Monday, 15 February 2010

Letter to Richmond & Twickenham Times on Quality Care Commission

26 January 2010


Dear Sir

All Richmond’s social care and health providers, statutory as well as voluntary, have to be registered with the Care Quality Commission by April 2010 - under the Health and Social Care Act 2008. Now a draft statutory instrument is ‘going through Parliament’ - or so the Primary Care Trust informs us in its Jan 19th Board agenda over 500 pages long - setting out 23 regulations in 259 pages, sub-divided into more than 40 outcomes (with ‘personal care’ heading the list).

This is micro-management run mad. Worse it is a legal requirement to register - and presumably to comply with the standards laid down - and failure to do so can result in an ‘unlimited fine or 12 months of prison.’ What is wrong with treating these standards as a ‘highway code’ rather than as a legal obligation, a gift to ambulance-chasing lawyers?

All is not lost however. Any statutory instrument can be halted in its tracks by Parliament - by MPs in significant numbers formally registering their objection - when matters are postponed for a later debate.

Vincent Cable, Twickenham’s MP, has already been urged to lodge such an objection - and it may have to be by the deadline date of this Friday (according to the Commons Information Office). For all his many qualities Vince calls himself a ‘parliamentary eunuch.’ Now he has the chance to demonstrate another of his claims, that he is a champion of ‘localisation’ - to which might be added democracy!

But a further question needs to be raised. The PCT has been helpful but how does the Council and its majority political party raise major issues such as these through its two MPs? Does it ever, and if so when? A similar question can be posed with the opposition party: after all they are Richmond’s MPs, representing all of us. And what about the voluntary sector - the CVS, LINk and its Key Strategic Organisations (such as CORLD), Council-funded so that it can speak with a stronger voice? These are interesting times, an election is not far off.

Yours faithfully

Francis King

East Twickenham