If you want to build a new hospital, there are more questions to be addressed than just how to pay for it.
As the continuing saga of the Kent and Canterbury Hospital rumbles on, some simplistic ideas and offers risk repeating the mistakes that got our local NHS Trust into this position in the first place.
As anyone who has had cause to use the services at the K&C knows, the buildings are simply not fit for purpose.
- Warning after deadly algae found at nature reserve
- Will authorities finally solve the curse of Longmarket parking?
While the staff struggle through with their customary willingness – and do an exceptional job, in my opinion – around them the facilities have been shoehorned into old buildings, inferior upgrades, out-of-date designs with prefab bits stuck into every available gap.
The place is a sprawling, hopeless mess. It seems that at least everyone agrees that there is no more point in investing in the current site.
However, one of the solutions being put forward is to have a new “shell” hospital built on adjacent land, freeing the existing site for housing.
Leaving aside for now the question of whether that is the best possible use of “planning gain” finance, it not only needs a commitment of up to £250 million to fit out the shell, but would locate the hospital back in what is a wholly unsuitable position.
The truth is that the placing of hospitals has long been problematic. Many, including the K&C, are based on sites acquired when the NHS was first set up.
Those original hospitals were often built where they had been established as charities – charities which were often set up hundreds of years ago.
Their location then was not ideal for a modern health service, and has become less so as towns and cities have grown around them, traffic has worsened, and modern medical practice has required more staff, more specialist buildings and more electrical power.
So if the opportunity arises to build a new hospital from the ground up, there are four factors which need to be taken into account: availability of land, accessibility, cost, and proximity to other health provision.
You simply cannot just throw up a new building on a site because it suits a developer, whether they are genuinely well-intentioned or simply using it as a tactic to get planning approval.
Nor is it viable to argue for investing more in an already unsuitable facility. Even if the government was willing to fund a fundamental re-build of the K&C, it’s still in the wrong place.
It’s not easy to access for emergency vehicles – and that’s going to get worse when Mountfield Park is built – the infrastructure is inadequate, and the site is already constrained which prevents future growth and development.
At the same time, the K&C doesn’t exist in a vacuum: it is part of the overall provision of hospital services in east Kent, along with the QEQM in Margate and the William Harvey hospital in Ashford, as well as a developing set of services provided directly in GP surgeries and by other commercial providers working for the NHS.
So the question of where to build is affected by the issue of what services should be provided and where, which results in decisions on what to build. Which of course then requires adequate investment.
The Government, is as ever keen to make the resolution of problems it has created the responsibility of someone else. So to unknot this conundrum the department of health has established what is call A Sustainability and Transformation Plan (STP).
As with the titles of most government programmes, you should immediately assume that neither sustainability nor transformation are the main objectives: if you wanted to do that, after all, you’d simply provide enough money. Instead, what the STP is doing, excruciatingly slowly, is passing the buck for decisions to the local GPs.
Here we risk getting into a soup of abbreviations. To simplify, GPs are now treated by the NHS as buyers of services from the hospitals for their patients, a process known as care commissioning.
So the area groups of GP practices which do this are called Care Commissioning Groups, or CCGs. And the problem that the government faces is that, to be blunt, the CCGs think that that the STP for east Kent is a disaster, and they are rebelling against funding its development, as Health Services Journal has recently reported.
Predictably, the mess created by continual NHS reorganisation, woeful under-funding and artificial marketization has resulted in declining service quality, poor morale, and a total absence of any sense of direction and leadership.
Thus, far from getting a new hospital at the K&C, we have a delayed consultation on an almost non-existent plan for the wrong development of the wrong premises providing the wrong services in the wrong place.
The end game will be that provision of critical health services is shunted around the county not to where it is needed but to where it can be provided at the least overall cost.
Yet again, something we are all going to need at some stage in our lives, a health service that most of us are proud of, is being destroyed by a contemptible mix of ineptitude, ideology and underfunding.
It’s time that STPs were stopped and the whole structure of NHS funding overhauled to make sure that we get the health service we deserve and pay our taxes for.