MEETING THE CHALLENGES
SIR GEORGE YOUNG'S RESPONSE TO CONSULTATION DOCUMENT
1. Since the Public Consultation Document was published in June, the Government have published "The NHS Plan" in July. Reading both documents, it is impossible to reconcile the message of one with the message of the other.
2. The consultation document is written in a language that looks for economies of up to £13m (page6); of reducing the numbers of beds and the number of treatments; of pursuing unpalatable options, later rejected, of closing an entire hospital, an accident and emergency department or reducing spending on primary care. (Page 11). No one who reads it could conclude that the provision of health care locally will improve. At best, the quality of service might conceivably remain the same while substantial sums are removed from the local health economy. The task is described (page 3) as making "the health services in North and Mid Hampshire both modern and affordable". But there is no mention of making them better.
3. The NHS Plan paints an entirely different picture - an ambitious vision of an NHS with substantial extra funds. "Real benefits for NHS patients; less waiting; faster more convenient care; improvements in elderly care services and the top priorities… visible improvements in the basics.. new focus on prevention." (Secretary of State's Introduction)
4. Para 12.15 states "As Chapters 4 and 5 described, the NHS Plan will see year on year increases in equipment facilities and staff. As the extra capacity comes on stream, so we will be able to reduce waiting times." In Para 12.19 it asserts "by increasing investment and making reforms, the NHS Plan will be able to deliver major reductions in waiting times covering all stages of acute care." This is a brave new world, putting behind the problems of the past.
5. Ministers who believe in joined up Government should be invited to explain what they expect people in Hampshire to make of these two wholly contradictory and conflicting documents, and which one we are expected to believe.
6. Chapter 3 of the Consultation Document makes it clear that one of the principle reasons for change is the financial position. It explains that the authority has been spending above budget; that the underlying issues have not been addressed; that the new money cannot be allocated to paying off the overdraft because the deficit would simply recur. But nowhere does the document challenge the basis on which the authority is funded - "For every 10 residents, we are funded for 8."
7. I understand the proposition that an authority with a well-housed population on above average income might experience less demand for health care than a disadvantaged population living in poor housing in an inner city. But nowhere is the current formula of 80% funding either explained or challenged. (It is particularly risky to use data on the general characteristics of the population, when only a very small percentage require hospital treatment each year.) If the formula is simply wrong, then the whole of the document is founded on a false premise. If the figure was 82.5% instead of 80%, there would be no recurring deficit to address.
8. The Supporting Analysis points out that "the difference between crude and weighted populations for North and Mid Hampshire is one of the most marked in the country…" This could give the answer to some of the questions in the Consultation Document, where it is asserted that "we spend more than others on acute and community hospitals"; "we treat more patients than we would expect for the population's needs" and "we admit more people for emergency care from the Andover Primary Care Group than other areas."
9. But unless hard evidence is produced that people are being admitted who should not be, it would be quite wrong to cut back services on the basis of a subjective formula. Indeed, the GP's would not accept it. For what it is worth, my experience as the local MP is that there are too many people waiting too long for operations that they need.
10. On Page 16, it says that "large savings are possible" through reducing the number of treatments in hospital settings, because "there is no obvious reason why the level of hospital treatments should be higher for the North Hampshire Primary Care Group than other areas." The document admits that more work is necessary to examine the reasons for this; but it the meantime, the savings are to be banked.
11. Andover Hospital is pencilled in for £200,000 of savings through "rationalising the site." But the text refers to priorities and options for improving some of the poor accommodation, and to the lack of maintenance in recent years. Andover Hospital is a key resource for the growing population of Andover. Between now and March 2002 - the date by which the Health Authority proposes to implement the changes - the imperative is to invest in Andover Hospital, not seek savings from it. It may well be that, after there has been substantial investment, there is scope for reducing the running costs of a modern, well-insulated and well laid-out building. But the document makes no reference to any such investment - only to a potential saving. This is not acceptable.
12. Under a separate heading, the document proposes to save £800,000 by "defining the appropriate balance of beds across Eastleigh, Andover and Winchester, involving agencies in both health and social care." Reducing beds in Andover, without providing a local alternative, would cut across the policy of providing care locally. If there are patients who are in Andover that should be in nursing or residential homes, then no one would argue that they should stay in hospital. But, firstly, this has resource implications for Hampshire County Council; and, secondly, the beds could be needed for other purposes - for example post-operative care for people who have been treated in Winchester or Southampton.
13. Elsewhere in the document, savings are proposed for the NHS (Page 15) by transferring the burden on to other agencies. But unless those agencies are resourced to cope, the savings will not be possible.
14. Throughout the document, it is assumed that reducing lengths of stay reduces costs. Lengths of stay should indeed be reduced where possible; but this is to permit the admission of those on the waiting list so they get the treatment they need. Unless there is no one on the waiting list, reducing length of stay does not reduce costs; it increases outputs.
15. Nowhere in the document is there any mention of the role which the independent or private sector can play in helping the Health Authority achieve its objectives. The NHS Plan states (para 11.1) "The time has now come for the NHS to engage more constructively with the private sector, and at the same time make more of its own expertise available to employers throughout the country. The private and voluntary sectors have a role to play in ensuring that NHS patients get the full benefit from this extra investment." The document goes on to mention concordats between the NHS and private and voluntary providers. Yet the consultation document is entirely one-dimensional.
17. My reservation about the document is that it is finance-driven, not care-led. The NHS Plan has a Chapter entitled "Our Vision: a health service designed around the patient." There is no sign of this in the consultation document, which is designed around the balance sheet. The savings are predicated on the basis of a formula that is nowhere explained or defended; some savings can only be achieved by extra investment elsewhere - which is not assured; and that savings are predicated from Andover hospital, which manifestly needs investment.
18. But the document has been overtaken by events. It is impossible to reconcile it with the NHS Plan. Ministers should be told that, if they wish the objectives in the NHS Plan to be achieved, North and Mid Hampshire Health Authority should be asked to withdraw their consultation document and draft another one that is consistent with the policy in the Plan.