Sunday, 31 March 2013

So, which A and E would you shut?



                IS BUST!

My ‘Merger Mania’ series drove all my readers away, well, nearly all of them. I still want the world to read it though, it’s a review of an academic study into the effects of merging hospitals. It looks at the costs savings, efficiencies, improvements in patient outcomes that result from them – there aren’t any.

If that was theory, here’s the practise of it all;

In the ‘bad’ old days the ‘National health service’ was just that – a service. There was a great big plan. It aimed to match supply and demand, within the constraints of how much money was available. Human beings and plans don’t always work out too well, that’s being ‘human’. But they try to get it right.

Then we had Reagonomics/Thatcherism. The market was the new big thing. A free market would ensure that supply met demand, and as a result the fittest hospitals would survive, the inefficient would go bust. The problem is, there is no free market in healthcare. There are just sick people. It isn’t a business.

Now the “Big Plan”, is for hospitals to go bankrupt. That’s not a very good plan.

Hospital “A” is really efficient, gets all the work and “makes” money like a business does.

Hospital “B”, loses work to “A”, loses money, goes downhill and then goes “bust”.

Hospital “A” takes over Hospital “B” and a new regime of efficiency is brought in, like a business takeover.

Over the last 2 years, Ashford and St. Peter’s Foundation Trust has been negotiating to take over Epsom Hospital. Epsom is miles and miles away from either Ashford or St. Peters, unless you are in a Mercedes and the M25 is empty. It never is. It’s a journey no one would ever make by car, if they could avoid it. Public transport just does not connect any of these places. Helicopter maybe.

Luckily the negotiations broke down.

Suppose it had gone through?

The only “asset” any hospital has that could make money is Land. People cost money.

So to save money, you would close departments, sack people, cut the wage bill to get fewer people to do more work. Can you guess I’m thinking ankles here?

You then sell off the land.

Ashford Hospital had a great Accident and Emergency department serving a local community. It’s been shut down (now you go to St. Peters) and most of the land around the Hospital has been sold off; first to Tesco’s for the supermarket and car park, now more has gone for housing.

So now you travel to Woking/Chertsey. When I was discharged the first time on a bank holiday, a taxi cost me over £30.

If the Trust had taken over Epsom; what would they have shut? There are no public transport links between the different areas.

Epsom has a big and well respected psychiatric unit as does St. Peters – which would you close? One area doesn’t need two.

Except this isn’t one area, the hospitals have no community connection, are many miles apart and no public transport. For patients with mental health problems, on medication and distressed, the journey is impossible. What about relatives visiting?

Which A and E would you have shut? You don’t need two in an area, that’s why they shut Ashford A and E already.

If you don’t believe this particular madness, my next post will cover the bizarre proposals coming from Slough.

Neil Harris

(a don’t stop till you drop production)

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