| 200 people attended the consultation meeting in Haslemere about the proposed merger between the Royal Surrey County Hospital NHS Foundation Trust and Ashford and St Peter’s Hospitals NHS Foundation Trust. The presentation talked about the benefits of merger with better integration and co-ordination of services, greater efficiency from shared IT systems and management and the development of new services in the area such as specialised cancer care. We were assured that there would be no loss of services, no cuts to frontline staff, no downgrade of the two A+Es and midwifery services would continue to be consultant led. The panel also talked about other plans to bring more services closer to where people live and in particular to enhance services at Haslemere and Cranleigh Hospitals. For Haslemere, ideas include expansion of the range of out patient services including a fracture clinic and expansion of imaging equipment such as X-ray and scans. There followed an invitation to the audience to raise any issues related to the merger, the plans for Haslemere or indeed any other health care issues that affected them. This led to a lively discussion where a range of important issues were raised. I was interested in the links between the issues raised by the audience and indeed by the merger itself and the wider political context of the NHS. This political context is characterised by two things: the impact of the Health and Social Care Act 2012 with its vision of the NHS as a market of competing providers with an increasing role for the private sector, and the unprecedented funding gap whereby the NHS has had to make £20 billion of “efficiency savings” in the past 5 years and will have to make a further £30 billion in the next 5. This has led, for example, to hospital trusts having to make annual 5% savings year on year, as well as cuts to mental health, general practice and ambulance service budgets. An audience member expressed concern about the fragmentation of current services and poor communication between services. The chair agreed that there was indeed fragmentation in the NHS and stated that he hoped the merger, by enabling better co-ordination of services could help overcome some of this fragmentation. Relating this to the wider context, I would say that such fragmentation has been exacerbated by the Health and Social Care Act as it promotes competition between health care providers over collaboration and co-operation. In many ways the merger proposal represents the antithesis of this as it is a process of reintegration of disparate services that will enable proper health care planning on a regional level – something that the H&SC Act with its vision of individual competing health providers cannot deliver. So the merger, because it will command wider resources and planning for a wider population, will enable a radical restructuring of cancer care services across the whole region, even down to the south coast, creating new specialist treatment centres and allowing repatriation of services that had gone to London. This can only be of benefit to local people. So far, so good… But in the current climate of hospital funding cuts I worry that the promise of the merger that front line services and staff numbers will not be affected, and that new services will be developed, may be difficult to keep. It is hoped that the efficiencies derived from the merger will save £10-15 million a year, but will that really happen and will it be enough? I believe we need to invest more in the NHS and increase its funding in real terms – 4% a year real terms funding increase is what the Kings Fund reckons is needed – if we want to develop services to meet the health care needs of a growing population and in particular a growing elderly population. The promise of the merger to improve services can only be realised if there is proper funding, otherwise the new trust may find itself with no choice but to make cuts. I noticed that the proposals for Haslemere Hospital were not included in the presentation slides and asked if they would be included in the outline business case but it was explained that the ideas for Haslemere were not actually part of the merger proposals. They were part of a separate set of proposals. An audience member expressed concern about outsourcing of care to the private sector and another described her personal experience of poor physiotherapy care provided by Virgin Health at Haslemere. She asked if there would be more privatisation of services. The background to her question was that Haslemere Hospital is run by Virgin Health and the leaflet that was handed out mentioned Virgin Care so it was reasonable to ask if these proposed new services might also be privately run. We were assured that the merger plans themselves did not involve any privatisation, however, the answer did not make it clear who would provide the proposed new services at Haslemere. The representative of the RSHC said they hoped they would be in the running to provide local services in Haslemere in the future. This is an important issue that is worth keeping an eye on. As hospital reconfigurations often entail cuts in bed numbers, I asked if this merger would mean any net loss of beds. The reply was that there may be a reduction in acute beds because of better care in the community preventing admissions or enabling prompter discharge, but that there would be no overall loss of beds as there would be an increase in specialist beds, for example, for stroke patients. This is rather concerning as there is in fact no evidence that better community care reduces hospital admissions. Even if it is hoped that they will do so, it’s clearly important that alternative community services are up and running and shown to be reducing hospital admissions before any hospital beds are closed. Other issues raised were the cuts to mental healthcare, in particular inadequate emergency mental health services out of hours, and problems with the ambulance service and in particular very long response times. These were not directly related to the merger as they were services run by other trusts, but were clearly a cause for concern and show how budget cuts are impacting on local health care provision. Mental health budgets have experienced greater cuts than other health care sectors, and the ambulance service is struggling to meet increasing demand with reduced budgets. A member of the audience asked why there was such a shortage of UK trained nurses in the country and asked who was responsible for workforce planning, as this was a problem that could have been anticipated. I was able to comment that there had been a reduction in nurse training places and also there had been a lack of proper workforce planning due to disruption of training structures as a result of the Health and Social Care Act. Poor public transport links from communities to the different hospital sites and lack of parking at the Royal Surrey County Hospital were also raised as serious issues. This exemplifies the interconnectedness of wider social issues such as public transport with health care and shows how we need joined up planning so that people can access services wherever they live. Overall I thought it was a really good meeting showing keen community engagement in health care issues. I felt the merger proposals and plans for Haslemere were positive, with the caveats about funding levels and privatisation that I mentioned above. The wider issues raised by people show how national health policies impinge on local circumstances and that ultimately to protect and develop the best possible services for local people we need policies at national level that support collaboration over competition and adequate funding for all NHS services whether that be hospital, community, ambulance or mental health services. |