Proper funding is more important for hospitals than location

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It’s not unusual for campaigns to get side-tracked into pursuing the wrong issues. Presently there is a risk of that happening with the campaign around health care provision in East Kent, where people are obsessing about where services are located rather than how the local NHS services are funded, resourced and delivered.

There is, in short, a real risk of discussions about hospital locations becoming a distraction from the need to ensure that we have enough doctors, nurses and beds.

This may, of course, rather suit the management of the NHS both centrally and locally since it pits the active campaigns in Ashford, Canterbury and Thanet against each other rather than focusing on the mismanagement and under-funding which has made the East Kent NHS one of, if not the, worst performing parts of the entire national system.

Let’s look briefly at the current woeful performance. The East Kent hospitals trust has massive and long-term waiting lists for elective surgery, with substantial numbers of patients waiting more than a year after referral by their GP. There are routine breaches of waiting times in accident and emergency. Almost none of the cancer treatment waiting time targets are being met. In common with much of the NHS nationally, there are chronic shortages of GPs, nurses and mental health staff.

Almost nothing has improved in the past two years according to an inspection of the Trust, undertaken at the request of Canterbury MP Rosie Duffield. At the same time, the local Trust is overspending by as much as £19 million each year, if the figures produced by management are to be trusted.

In this context, the Government’s decision to increase funding for the NHS is welcome, if likely to be inadequate. But it won’t solve the problems in East Kent, not least because much of it will be swallowed up in paying off debts incurred during the persistent under-funding since 2010.

More pertinent though may be the question of whether the management of this failing Trust are the right people to resolve the issues, and why their existing proposals are likely to provide the necessary curative solutions.

The constant changing of national structures and management has been a curse of the NHS for 20 years, at least. So, despite the obvious misgivings people have, it’s not necessarily the right starting point to condemn the local management as a whole, when problems are widespread across the entirety of the service.

Indeed, although it hasn’t necessarily been popular, the one area where the Trust has actually followed clinical, rather than financial, priorities has been the review of stroke services where the proposed changes are in line with good practice implemented elsewhere under the last Labour government.

So if we assume that at a clinical level there is the nous in the current East Kent management to solve the problems, what is stopping them? Leaving aside the not inconsiderable issue of inadequate funding the answer, perversely, may well be in part the very campaigners who are striving to save the services. Because, as I’ve noted, they have become fixated on “where” rather than “what”.

People have an emotional attachment to their local hospitals. Partly that’s nostalgia, partly civic pride, and partly fear of services becoming too remote. All those are understandable: our local hospital is the place our children are born, our wounds healed, and our parents cared for. Any self-respecting major city is bound to feel that a major hospital is a key part of it’s make-up and status, the more so if it happens to be a university city.

And quite understandably no-one relishes the thought of a 30 plus minutes emergency ambulance journey to the nearest major hospital if we lose our own local resource.

All these, though, are subjective issues. The key to modern health care is to have enough of the right specialist staff and equipment and bed spaces close enough to the population to get them to the care quickly – in other words, for specialist care you have to take the people to the doctors, not the other way round.

Thus it is that if well-meaning campaigners force the Trust to maintain three hospital sites with similar services then the financial cost of keeping those three sites operational will lead directly to fewer staff and fewer beds. The direct consequence will be worse, not better, health services for our population, which is the exact opposite of what people believe themselves to be fighting for.

So let’s step back. The fight should be for sufficient funding for present needs and to pay off accrued debts, and for adequate investment to bring the system up to standard and prepare it for the future. Focusing on keeping the local hospitals may be emotionally satisfying, but it won’t solve the problems the East Kent trust faces.

Arguing for proper funding, of course, requires some people to face the consequences of their support for the 10 years of austerity which has undermined our NHS. But just because it’s politically uncomfortable isn’t an excuse not to confront the reality: the NHS in East Kent needs radical surgery, sooner rather than later.

 

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