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


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