THE CRISIS FACING BEDFORD HOSPITAL AND OUR NHS
By Patrick Hall, Labour Parliamentary Candidate for Bedford & Kempston
Most people in Bedford and Kempston are aware that health services are under pressure, particularly Bedford Hospital. Bedford is not alone; many district general hospitals are running growing deficits - in Bedford it is £10M and Milton Keynes £20M+.
This is principally as a result of the relentless financial squeeze imposed by the Conservative-Liberal Democrat Government. The National Tariff is a menu of prices which the Department of Health pays for operations, interventions and other work. It is being cut by 1.5% per year. Add NHS inflation of 2.5% and in effect 4% is being cut in real terms from hospital budgets every year - a situation set to go on and on if the Tories should win the next general election.
The price is being paid in the first instance by NHS staff, thousands sacked, increments stopped, a maximum 1% in the pay budget which, taken together with the effect of higher pension and national insurance contributions, means for thousands less pay whilst the Government exhorts them to work harder.
Another consequence of the squeeze is that, even if a hospital performs well, the finances do not stack up - growing deficits, relentless cutbacks, rising financial penalties all tell the same tale.
Pressures experienced in primary care, where, across the country, it is taking longer and longer for patients to see their GP, together with a growing and an ageing population and the effects of huge cuts in adult social care, all combine to put hospitals and accident and emergency departments in particular under strain and increase patient waiting times.
That cocktail of financial and operational pressures has been a driver in hospital trusts looking to merge. In Bedfordshire we have gone through the fiasco of Healthier Together which failed to generate the support required. Therefore the Foundation Hospital regulator, Monitor, together with the non-foundation support organisation the Trust Development Association, paid health consultants McKinsey £3M of NHS money to produce the Bedfordshire and Milton Keynes Healthcare Review which the Clinical Commissioning Groups in Bedfordshire and Milton Keynes have used as a basis for a public engagement exercise looking at care closer to home and care in hospitals.
Of course it makes sense to offer more effective care in or close to people's homes. This would reduce unnecessary hospital admissions enabling hospitals to concentrate upon acute care and reducing waiting times.
Part of such an approach is already happening in Bedford with hospital based diabetic services. It is well known that, owing to increasing levels of obesity, the incidence of obesity is growing fast. However, in Bedford, thanks to the lead taken by the hospital, more patients are being seen and looked after - but fewer need to go to hospital to receive treatment.
However, for this to become a sustainable model justifying a reduction in some activity on hospital sites, we will need to experience years of development of primary and secondary health services. The political will does not currently exist to achieve that, nor does the funding. And if and when we get there, that does not mean a reduction in the role of the hospital, as is illustrated by the diabetics example.
The McKinley Review looked at 36 options, reduced to 14, then 5 for the future of Bedford and Milton Keynes Hospitals.
All 5 of them involve a downgrading of one or both hospitals in respect of emergency surgery which is described as 'financially and clinically unsustainable'. I understand that this assessment is not supported by local clinicians and many GPs.
The Review is based upon the Keogh Formula which looks at the numbers of doctors and nurses needed to deliver a safe service - then calculates the size of population which would generate the right amount of work to keep these clinical teams busy. But the real world is much more complicated than that - there is travel time for example - the effects upon patients and their families of lengthy travel to access emergency surgery. Above all, Keogh ignores the quality of existing services. In other words, potentially disruptive change is proposed even where services are delivered to a high standard.
This is not the way to proceed.
To this finance-driven rush to merge and downgrade, add the Health & Social Care Act. It did not feature in the manifestos of the Conservatives or the Liberal Democrats in 2010. It did not form part of the Coalition Agreement after the election. Yet, it has brought about the biggest and most unwanted reorganisation in the history of the NHS, costing £3B at a time of austerity. It includes, for the first time, the mandatory open tendering of NHS services, the involvement of the Office for Fair Trading and the Competition Commission in deciding the shape of NHS services. This has the effect of bogging down health authorities with complex and expensive legal and administrative procedures concerning competition law, diverting attention from what the NHS should be about - delivering high quality care to all, free at the point of use, on the basis of need, not ability to pay.
That is the principle upon which the NHS was created, as relevant today as it was in 1948; a principle no longer safe with the Tories and Lib Dems.
In Bedfordshire NHS musculoskeletal services were put out to tender in 2013. The outcome of the competition was a successful winning bid from private healthcare company Circle Health - now in charge of a £120M five-year contract. Circle does not have the capacity to deliver the work itself and must ensure that NHS hospitals do some of it - but how is this happening? In the Bedford area, Circle has given some operations to The Manor private hospital in Biddenham - taking work away from Bedford which is already strapped for cash.
This is just one example of fragmentation and privatisation of the NHS. More and more will follow - a key example of how this Government's approach is undermining Bedford Hospital.
And Circle Health is duly grateful - last year it donated £1.4M to the Conservative Party.
I have no doubt where this direction of travel will take us. The reduction in locally available NHS services for reasons of cost (dressed up in clinical rhetoric), combined with increasing control by the private sector, will lead at some point to private health providers offering locally accessible care, in the name of choice, as long as people are willing and able to pay. Hence my contention that the basic principle of the NHS is no longer safe with the Conservatives and Liberal Democrats.
Where do we go from here (August 2014) with regard to Bedford Hospital?
It is essential that hospital stands up for itself and makes a robust case for its future and it is essential that staff and the public do the same.
The official consultation on the CCG's proposals - which may be different to those of the McKinsey Review - is due to take place this autumn with the result announced in the winter. I doubt it. In May 2015 there is a General Election. It is not inconceivable for the whole thing to be kicked into the long grass until next summer. We could therefore have this damaging uncertainty hanging over us for almost a year - another example of this Government's destructive approach to the NHS.
All that said, whatever the Coalition Government may do, it is in my view important that we make a positive case for the NHS, our hospital and local health services. I am certain that Bedford Hospital can have a bright future.
The hospital does not, cannot and will not do everything.
It makes total sense for local people to travel to Papworth and Addenbrookes for specialist treatment giving patients the best chance of success. This has been the case for years. Already, Bedford works with Luton and Dunstable, Milton Keynes, Lister, Addenbrookes and Moorefields hospitals.
Bedford is the vascular surgery hub for Bedford, Milton Keynes and L&D. The results are excellent. Patients from those other areas come to Bedford for treatment. The L&D is the facial-oral surgery hub for Bedford, MK and L&D - so local people travel there.
Bedford Hospital enjoys a close relationship with Addenbrookes in cancer services, urology, paediatrics and neurology. Some doctors have been jointly appointed by Addenbrookes and Bedford, working some days in Cambridge and others in Bedford. That helps with attracting quality staff. Local patients can go to Bedford Hospital and their condition discussed with specialists at Addenbrookes by video conferencing. Many involved in the service think that closer links - including A&E - would make sense.
But all of that exciting and innovative partnership work requires that there be a secure and strong core of services at Bedford Hospital - especially A&E, paediatrics and maternity - plus closer links with community and GP services.
All of this is possible, some is already happening. There is the knowledge and the skill and the will out there to develop and improve services in this way. That is the direction to travel.
Beneficial change, not downgrading.
It can be be done. But this Government stands in the way.
Marketisation, privatisation and austerity for years to come will break up our National Health Service. It won't happen overnight, it will proceed in different ways in different places at different speeds.
But it is taking place.
It is insidious. It is an absolute disgrace.
Even Margaret Thatcher with a huge Tory majority did not attempt to go that far.
Yet now we have the Conservatives and Liberal Democrats combining to do something which will destroy an integral part of the British way of life.