Outlook Even Gloomier for St Helier Hospital

November 9, 2006 1:49 PM

Tom in front of St Helier AmbulanceCommenting on the letter sent by David Nicholson, the Chief Executive of the NHS, to all MPs Tom Brake MP for Carshalton and Wallington who has St Helier Hospital in his constituency said,

"David Nicholson's letter is just another indication of the threat that St Helier Hospital is under. He understates the case when he says that, 'I appreciate that changes to much loved local services often provoke strong emotions and opinions'. The local community have an opportunity on November 25th , when we march on St Helier Hospital, to show just how emotional they will feel if the Accident and Emergency or worse still the whole hospital at St Helier is closed."

The text of the letter was as follows;

Dear colleague

Since I took up the post of CE of the NHS eight weeks ago, there has been a lot of concern expressed about proposed service change and reconfiguration. I know that as Members of Parliament you take a keen interest in local services for local people, and so am taking this opportunity to set out in brief some of the key drivers of change at a national level.

Although change in the NHS is often perceived as a response to failure (and historically this has sometimes been the case) it is also an essential part of service improvement. This is not to deny that there are other factors at work, such as the need to comply with the European Working Time Directive and the need to achieve financial balance. I am in no way complacent about the small number of Trusts currently in deficit, and make no apologies for wanting a health care service that is financially sustainable as well as clinically sustainable. However, I also want to make clear that there are other drivers of change, such as developments in our capacity to prevent, treat and cure patients.

The NHS at a local level is responding to these drivers by developing a new model of care. Put simply, this can be described as providing care closer to people's homes where appropriate, with centres of excellence for more specialist care where clinically necessary, both complementing the services of District General Hospitals.

These reforms, together with technological advances mean that more care will be conducted outside the four walls of hospitals. Primary care practices are increasingly providing a range of services such as minor surgery. Community Matrons are working in the community with expert patients to help people to manage long-term conditions such as asthma, CHD and diabetes, improving health and avoiding unnecessary hospital admissions.

When people are admitted to hospital, more and more procedures are carried out as day cases. Of those patients who do have to stay in hospital for longer than one night, we are witnessing a long-term downward trend in the average length of stay. All of these changes are positive for patients and their carers, but they are having a real impact on the numbers of beds required by acute hospital and where and how NHS staff work.

It is vital that the patient receives the very best possible care, and sometimes the best care maybe in a specialist regional centre rather than their local DGH. At a specialist centre it is more likely that clinicians and nurses will see enough patients to develop the skills necessary for an enhanced outcome. For example, National guidance from NICE states that specialist urology teams should carry out at least 50 radical prostate or bladder operations a year.

All this points to making sure that the patient gets the right treatment at the right time in the right place. And the answer will be different in different localities.

We are starting to see a health care system with fewer beds in the acute sector for a whole range of conditions, with the ability of primary care to perform minor surgery and the increasing skilled nature of our paramedic service requiring a re-think of how we provide urgent care. Our aim should not therefore be to preserve the status quo, but to think imaginatively about how we can unlock the resources, both in terms of money and people, to re-direct them where most benefit can be achieved for patients.

The NHS has a duty to respond to the changes that technology, skills, patient needs and resources are driving. These are not easy or simple decisions to face up to. If the NHS lacks imagination or courage, then it will revert to a series of quick fixes, rather than seizing the opportunities there are to transform the provision of care. I have asked Sir Ian Carruthers, who has over 30 years experience in the NHS, to work with SHAs to look at their proposals for service change with a view to identifying areas where further support is necessary. This work will ensure that due process is followed and that best practice is shared across the NHS. Any changes will be a matter for local decision making, and subject to consultation and independent scrutiny.

This letter has been necessarily generic, but I would urge you to contact the CE of the Strategic Health Authority in your area for a more detailed discussion about possible changes that may be taking place to health services in your locality in the future. I appreciate that changes to much loved local services often provoke strong emotions and opinions. The NHS certainly needs to improve how we listen, engage and respond to the genuine concerns of the public, patients, clinicians and other stakeholders. I genuinely hope that we can work with you at both a national and local level to develop a mature and open debate about not just how many hospitals we have, but how many more lives we can save and improve.

Yours sincerely

David Nicholson CBE

NHS Chief Executive

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