Our local hospital, built through the PPFI recently, is about £90 million in debt. The major part of this debt is directly due to problems associated with the PPFI. This is not the only hospital with this problem. Because of the effort in meeting targets for cancer, heart disease and obesity there is difficulty in getting prompt treatment for other illnesses. For example, the diagnosis and treatment of osteoporosis, a debilitating condition affecting 1 in three women, a far greater incidence than breast cancer (1:10) and probably greater than that of cardio vascular disease. I support the argument that targets are an emergency measure which must, sooner rather than later give way to a less dogmatic system. The idea of fining hospitals for high degrees of infection is a bad one; help and advice is surely better.
The report illustrates problem areas, but action to solve these is not only frequently absent but contra-indications exist. For example, one must welcome any emphasis on preventative measures—the pressure to stop smoking is at least one good example—but treatments for obesity carry a different picture. Why no statutory action to stop unnecessary levels of, for instance, salt or sugar in foods? If occupational health is exampled as a success, why have the number of Health and Safety inspectors been cut. And when many examples given in the document highlight poverty as the main underlying cause of many areas of ill-health, how can we continue to see an increase in the gap between the well off and poorer members of our society?. Virtually every day sees a report from one organisation or another pointing out our governments failures in many areas, including aid given for the care of the elderly.
In my mind there is some confusion/double talk when part of the document refers to patient choice and others to clinical needs ruling. It proposes greater public involvement, with hospital provision being decided on local needs. It writes about the need to concentrate treatments on poorer areas: how does this square with inreased levels of inequality allowed by our government, or with the ‘Picture of Health’ road show in London where the presentations and questionnaires have pushed towards acceptance of the closures of local hospitals?
If local hospitals are to change—and I for one am not unsympathetic to many of the reasons for doing it—where does that leave patient choice? (A chimera, in any case.) And since when has patient choice, or even drug efficacy played a serious part in NICE’s deliberations?
In the section on dentistry it actually suggests that the service ‘may’ be poor in some areas! May be poor! On what planet do the authors live? A very recent survey shows that since Labour’s reform programme a further loss of access to dentists of a quarter of a million patients!
The paper refers to a closer working between hospital trusts and the local authorities. I believe Bromley is a good example of this. But it also offers a good example of the inflexibility of financial formulae where Bromley, with, I understand, a higher number of older people and sufferers of autism than in inner London Boroughs and yet receives half the RSG compared to those Boroughs. (It also boasts one of the lowest coucil tax rates, so perhaps that may have something to do with this situation!)
The paper explores the use of more private facilities in the NHS. I know this is controversial. For me, getting treatment would be paramount; but one is aware of penalties currently involved where comparison is made between the private provider (tackling straightforward cases) and the NHS which has to take on any case and frequently those the private firm will refuse to take.
The document also stresses the importance of carers- I note that Bromley is one of the many areas where there have been cuts to the provision of care, including the revision up of criteria needed to attract care. Here, and I believe other areas huge damage has been done to provisions for learning difficulty users because of the paper ‘Valuing People’. In Bromley, the closure of good day centres has left a hugely reduced drop in facilities for day service users. In part this is due to the costs and lack of specific governent support which allows this Tory Boro’ to opt out of its moral responsibilities.
The final section deals with mental health—it has always been a Cinderella service—talking about the problems is no solution to those problems. Bromley has some new, purpose designed facilities but lacks, as in other areas an out of hours service. It gave a couple of interesting statistics; the number of black/minority/ethnic patients in mental health units is 1:5, whereas in the population as a whole the ratio is 1:10. Food for thought?