Thursday, February 15, 2007

CHSG Reponse to Towards 2010



The West Birmingham and Sandwell catchment areas are both extremely deprived especially West Birmingham, and they both have a great diversity of ethnic groups. These factors mean the population has more small for dates babies, more congenitally abnormal babies, a higher perinatal mortality rate, more hypertension, more diabetes, ischaemic heart disease, more strokes, more chronic lung disease, more cancer, more violent injuries, more self-harm, alcohol and drug abuse than more affluent and less ethnically diverse areas.

It makes sense for the areas with the greatest health care needs to have the best access to and provision of health care services both primary and secondary. To date there has been remarkably little investment in the health care infrastructure of the area.
City Hospital Supporters Group welcomes the proposed investment of £695 million in buildings but is concerned at the possible fragmentation of the investment and questions the impact this will have on the delivery of services especially in the secondary care sector.


· £200 million of the above figure will be invested in new and refurbished health centres which is good for primary care and this leaves £495 million for a new specialist hospital fit for the 21st century plus new community hospitals and community treatment centres on the current Sandwell General Hospital site, Rowley Regis Hospital, on the current City Hospital site and also at Aston / Perry Barr and at Sparkbrook / Springfield.

· The question is how much money does this leave for a proper hospital? A major concern is that it will not be enough.

· Will people still need to be admitted to a proper hospital in 2013? The very simple medical answer is yes of course they will. If you are seriously ill you need care in a proper hospital bed looked after by an adequate number of staff not too far from home. At the moment City Hospital has 700 beds when they are all open, and Sandwell has 400 beds giving 1100 beds in total. In the Trust’s summary consultation document they do not mention bed numbers. I understand there will be something over 600 beds which means a cut of about 500 on the present total of the two hospitals. This is a swingeing cut. However I believe there will be 200 to 300 beds in community hospitals. The bed numbers need to be explicit.

· Bed occupancy has to be a major issue. Currently in this Trust like others throughout the country we are practising industrial production line medicine. It is all about high turnover with low production costs in the best business tradition. The aim is to put the most patients through the least number of beds requiring the lowest number of nurses possible. It means bed occupancy figures of over 95% and even over 100% have been tolerated. This has led to all the problems that are now an every day occurrence. Patients pushed into any available bed, some patients admitted to a ward of the other sex, the need for draconian target times for patients to be admitted, with the Chief Executive’s P45 depending on meeting the targets, patients with infections being admitted inappropriately. The question is what is bed occupancy going to be in the new specialist hospital? If we had an occupancy of 80% and certainly not more than 85% like some of our continental friends we could avoid the awful problems mentioned above. Bed occupancy in the new hospital needs to be explicit.

· What about community hospitals? What is the record on these institutions in the UK?. Well surprisingly during the last 30 years or so every effort has been made to close down community hospitals. Why? They were found to be places where patients languished without a very good quality of care. The patients were transferred to acute hospitals so they could receive a full range of integrated care. Why are we revisiting the past?

· Fragmentation of the clinical service and lack of joined up care could be real problems with the new system being proposed. The more separate institutions that you have the more barriers there will be to the smooth journey of the patient from illness to health, the more travelling time for the health care professionals. Do we need so many community hospitals? It makes sense to have intermediate care or community beds on the City Hospital, Sandwell Hospital and Rowley Regis sites but do we need the others? Why not facilitate a lower bed occupancy at the new hospital by increasing at least potential bed numbers and sacrificing two of the community hospitals?

· Another very real worry not touched upon in the consultation document is to move more and more of acute illness into the community setting to be carried out by General Practitioners and Nurse Practitioners leaving the hospital to look after the seriously ill. This is a development which does not have a sound evidence base. It is in reality third world medicine chosen for its perceived cheapness rather than its suitability to a first world country and England’s second city. If it has not been chosen for the residents of Edgbaston, Sutton Coldfield and Solihull who are in far better shape why have it in poverty stricken West Birmingham? We need to remember that today’s mild or moderately severe illness effectively diagnosed and treated in secondary care with early discharge if appropriate will avoid a number of serious pitfalls.

· If the Birmingham Treatment Centre and the Sheldon Block are all that is eventually left of City Hospital it will leave the BTC with no on site support. If a patient presents with an illness requiring immediate admission, if another specialty is required urgently, or if a day case operation becomes complicated requiring more complex intervention and admission, presumably urgent transfer elsewhere will be the only option? Is this 21st century care?

· Lastly we do not believe the local community has been fairly consulted on what is proposed. They have only been presented with one option and the full implications of what has been proposed have not been explained. This is a community where more time and effort needs to be committed to ensure a truly meaningful consultation. What proportion of the population even know about the changes proposed? Furthermore the Trust have had two consultations running at the same time making it difficult to do justice to either.


The new capital investment proposed is welcome and desperately needed. The people of West Birmingham and Sandwell deserve and should demand a proper secondary care hospital with a full range of services on one site. This should have an adequate number of beds designed for an occupancy of 80-85%. Even if all the beds did not open from day one there should be space to open wards as they may be needed It should have a comprehensive A&E Department that at the very least can handle the emergencies currently seen at City and Sandwell Hospitals combined. It will serve 500,000 people and it should be able to do them justice. If the staff of that hospital have the right conditions they will deliver a magnificent service.

A nightmare situation that must not be allowed to happen is as follows. An unsupported Birmingham Treatment Centre on the Dudley Road site with a community hospital in the Sheldon Block. The rest of the hospital is demolished and the land sold for the rich pickings of developers. Sandwell Hospital suffers a similar fate. We are left with some inadequately sized hospital at a venue to be decided with several community hospitals that will be filled with those who have nowhere else to go. The dedicated staff providing a great service today, who are far more important than buildings will have long since left for greener, more sensible and coherent pastures.

A really good secondary care hospital with excellent health centres and primary care facilities and three community hospitals has surely got to be the way to go providing seamless care that is cost efficient. The development of primary care by the destruction of secondary care must not be allowed to happen.

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