Some initial thoughts on the Consultation Document “Working Together to shape Local Services for People who live in and around Andover”
I listened with interest to Barbara North’s introduction of the consultative process – appropriately launched in the Conference Room at Andover War Memorial Hospital. As Chair of the Winchester & Eastleigh NHS Trust, which runs the hospital, she will have responsibility for running the consultation exercise and then, with her colleagues on the Trust, deciding what to do next. It was clear from the reaction of those at that launch – staff, patients, councillors, journalists – that this is a subject on which feelings run high. Yes, we want a new hotel for the town; and a refurbished Cricklade Theatre; and a new multi-screen cinema; and some better shops. But the hospital stands in an institutional class of its own – a symbol of a growing and confident town’s social commitment to its citizens, a testimony to the philanthropy of our forebears; and a constant source of comfort to those in and around the town that professional care is at our doorstep. Anyone who launches a debate on the future of the hospital must realise that is a very hot potato.
Barbara presented the case for change professionally and, in principle, I am not opposed to change. Medical technology is changing; there are different and better ways of treating people ; and the NHS has to re-configure itself to provide modern services. Andover Hospital has changed and evolved since 1924 when Henry Gamman gifted the land to the Mayor of Andover for a Hospital in remembrance of the Great War.
I liked much of what I heard Barbara say – the outdated buildings on the site need modernising, so our professional staff can treat people in better conditions; there is a need to reduce the amount or travel to Winchester for diagnosis or treatment; all the proceeds of the sale of the land will be re-invested in Andover Hospital ( and this will be topped up by capital from elsewhere). So far so good.
And I accept, albeit reluctantly, the logic in the document about a "hierarchy of care" - with the expensive specialised services being provided at Southampton, the District General Hospital being at Winchester (at any rate, for the time being) and local services being provided at Andover.
But there are a lot of questions that need answering. Can we provide the improved and hopefully increased health services we need in the reduced space, behind a new residential development on Charlton Road? Is there the same commitment to provide new services in Andover as there is to move existing services to Winchester? I found the language of the document worrying. The capitals are mine.
“We PLAN to provide all day surgery requiring a general anaesthetic at Winchester. We HOPE to provide more operations for people who only need a local anaesthetic at the Andover War Memorial Hospital.” I think we should start from the premise that, for every procedure that is transferred from Andover to Winchester, at least one should be transferred the other way, so there is a net reduction in the net to travel and a net increase in local treatment.
Halving the number of outpatient clinics, as proposed, may make sense in terms of optimising the use of consultants; but it will mean less choice for local people.
The estimate of £2.5 to £3.5m for the capital improvements needed at the hospital sounds low to me.
What is quite unacceptable is the £500,000 we have to find this year for what the government are pleased to call Estate Impairment Loss. Let me explain how I think this works. The Government have asked Health Trusts to look at their land and buildings, and to dispose of that which is surplus to requirement. So far, so good. In the case of Andover, the market value of the land that is being released is £1.5m. However, some civil servant somewhere has decided that the land and buildings are worth £4.2m to the NHS – (how this figure is arrived at is a total mystery.) The local Trust says the buildings are surplus to requirement – in other words, it doesn’t need them - and the developer says the land is worth £1.5m. If this was just a paper dispute, it wouldn’t matter. But the civil servant has then turned on the Trust and accused it of “losing” £2.7m – the difference between the £1.5m that the land is worth, and the fictitious figure of £4.2m – and then demanding compensation for this “Estate Impairment”. So, far from having £1.5m of capital receipt to invest, the Trust has a deficit of £2.7m which it has to find from its budget. As an act of generosity, £2.2m of this “loss” is written off, leaving the trust with half a million pounds to find from this year’s cash strapped budget. This is a stealth tax to cap all stealth taxes! Worse, it is a health tax as well.
The figures show that, this year, the extra costs of the changes at Andover will be £340,000. Will the Trust have to find this from its existing budget – making savings somewhere else? If not, where will this money come from? Nearly all the Trusts are running deficits and the Government has told everyone to balance the books this year.
The capital works at Andover will be “subject to the NHS Business Case process”. This rings alarm bells. Will we find, as we place the contract for the new outpatients department, that the business case has not been made? Can we have clearance before we make the economies that the investment will follow? The document tells us that “If these plans are agreed, the changes will be phased over the next two years and will be dependent on capital funding.” If Gordon Brown has less money for public spending in two years time, will we be told that the funds for the improvements are not available – after we have agreed to sell the land, close the beds and made the savings?
These are my initial thoughts, having read the document rather quickly this evening. They may evolve as constituents write to me and as I attend the public meetings that are being organised. And there are two more this week.
Let me know what you think.