Fear in the community
Ross Clark reveals that the government has a hidden programme for mass closure of local hospitals The local people who turned out to see Princess Helen Louise open the new wing of St Leonard’s Hospital in Sudbury, Suffolk, in 1938 would not have recognised the term ‘stakeholder’, but they would seem to have fitted perfectly Tony Blair’s vision of a breed of socially responsible citizens helping to run the country’s public services. ‘They paid for the hospital through voluntary subscriptions of a few pence a week,’ says local historian Barry Wall. ‘The hospital had been built in 1867 using the proceeds of the sale of the site of an old leper home which had been in existence since the reign of Edward II. But it was local people who paid to keep it going. As a child I remember fêtes, regattas and gala days, all in aid of the hospital.’ With the creation of the NHS in 1948, the local community effectively gifted the hospital to the state. The NHS gradually ran down St Leonard’s and transferred many of its services to Walnut Tree Hospital, a former workhouse in the town, but the people of Sudbury, through a league of friends, have continued to support their two hospitals, and defend them against cuts, ever since.
It has taken the Blair government, for all its blather about ‘stakeholding’ and for all the billions it has ploughed into the NHS, to rob the town of a hospital for the first time in 140 years. Pending a consultation exercise or at least a theoretical consultation exercise — the Suffolk West Primary Care Trust will later this year close both St Leonard’s and the Walnut Tree Hospital for good. Townsfolk in need of an outpatient’s appointment with a consultant will instead be sent to the West Suffolk Hospital in Bury St Edmunds, 20 miles or a 75-minute bus ride away. The mainly elderly people who use the 32 in-patient beds at the Walnut Tree Hospital will either be transferred to the West Suffolk Hospital or will be sent to recuperate at home. Meanwhile, plans for a brand new hospital in Sudbury, which was first proposed in the 1960s and is now promised for 2007, have been scaled down to a bedless building called the Sudbury Health and Social Care Centre — or a ‘glorified GP surgery’, as locals put it.
For many of the 300 Sudbury folk who marched through the town last Saturday in defence of their hospitals, the planned closures are a local issue. But there is a growing realisation among campaigners that they have fallen victim to a hidden national programme of mass closures of cottage and community hospitals. Patients were also marching last week in the New Forest, where five cottage hospitals have been earmarked for closure. The people of Withernsea in the East Riding of Yorkshire have also been told they may lose their hospital, along with Felixstowe, Aldeburgh, Henley-on-Thames, Wantage, Wallingford and Didcot. Perhaps not surprisingly, given the result of the government’s decision to close the accident and emergency department at Kidderminster Hospital ahead of the 2001 general election — retired consultant Richard Taylor won the seat by a landslide and retained his seat in 2005 many closures are being conducted by stealth, with activities gradually scaled down to the point at which the final closure is a relatively small matter. Evesham Hospital is to lose two wards, Malmesbury its maternity ward. The cottage hospital at Wells-next-theSea in Norfolk closed last Christmas, supposedly in order to bring a bug under control, and has never re-opened. The 16 in-patient beds at Bradford-on-Avon Hospital, Wiltshire, were closed with three days’ notice in early August, again supposedly as a temporary measure, in reaction to staff shortages. Yet last week West Wiltshire Primary Care Trust announced that they will not be reopened. The outpatients’ department is now also to close, along with most departments at nearby Westbury Hospital.
In the case of each closure locals have been promised that a move towards homebased care will eradicate the need for hospital beds. The consultation document put out by the Suffolk West Primary Care Trust, ‘Pathways for Change’, is full of platitudes on the benefits of the new district nursing service it claims to be setting up, ‘Intensive Case Management’, whereby a fleet of travelling nurses will change dressings and attend to bedsores. For most people, the paper asserts, without providing any evidence, ‘rehabilitation tends to progress more slowly when they are in hospital than when they are at home’. Yet even the platitudes cannot disguise the real reason why Sudbury and so many other small towns are to lose their hospitals: a vast misallocation of resources. Like many primary care trusts (PCTs) — local bodies which the government set up in 2002 — Suffolk West has run out of money. Unlike the old health authorities, which were allowed to run up temporary deficits, PCTs have been told they must balance their books by March 2007 — hence the sudden scramble to close community hospitals and cash in by selling their town-centre sites.
Given that the NHS has seen its budget increase by £69 billion this year, and double since 1997, it is astonishing that it has managed to manufacture a cash shortage. But as Suffolk West PCT concedes in its consultation document, the effects of the European Working Time Directive and the government’s new contracts for GPs have been crippling. It might also have mentioned the cost of compiling data for the government’s compulsive target-setting — a task which occupies a growing number of the PCT’s 650 employees. Many PCTs are also burdened with the cost of paying for brand new district hospitals built under private finance initiatives (PFIs), deals which some PFI companies have succeeded in renegotiating at a higher cost to the NHS than was originally envisaged.
At the same time as turning elderly people out of their hospital beds, PCTs have frittered money on consultation exercises, which it now seems are being entirely ignored. Sylvia Byham, chair of the Sudbury hospitals’ league of friends, is fed up with sitting down with NHS bureaucrats to discuss a new hospital in Sudbury — something she has been doing for 20 years. ‘Primary Care Trusts seem to change their chief executives like I change my socks,’ she says. ‘Last year we won a battle to save the Walnut Tree Hospital, which was then threatened with closure on the grounds of fire regulations. Now we are told it is going to close anyway — and the replacement hospital which we were promised two decades ago isn’t going to be built. A lot of money was spent making the Walnut Tree Hospital comply with fire regulations — money which will now be wasted.’ John Cottle, chairman of the league of friends of Bradford-on-Avon Hospital, has had a similar experience. ‘West Wiltshire Primary Care Trust has been holding “assemblies” of healthcare workers and patients’ groups all year to discuss the future of healthcare in the area. There have been four assemblies, each of which takes up a whole day, plus preparation time, and involves 150 people, including doctors and nurses who could otherwise be looking after patients. The closure of local hospitals was never an option put to us, yet in spite of all the time spent in the assemblies, now we are being told that Bradford-on-Avon will lose its hospital. The assemblies were a nonsense; I am sure the decision to close the hospital had already been made. It shouldn’t be the NHS’s to close down. It started off as a community hospital, which the people of Bradford-on-Avon paid for out of subscriptions of a few shillings a week, and which they gave to the NHS in 1948.’ As for the home-based care which is supposed to replace cottage hospitals, there is little evidence it will save any money in any case. The Suffolk West PCT claims that closing the two Sudbury hospitals will save £4.12 million a year, while the provision of home nursing care will cost only £1.51 million a year. But those figures are disputed by Sudbury GP Roderick Donnelly. ‘The PCT hasn’t got the infrastructure set up to carry out care in the community, and if they did I can’t see how it would be any cheaper than the current system,’ he says. Besides, he adds, caring for people in the community is bound to be less efficient: ‘If you have nurses driving around seeing lots of patients, they are going to be spending half their time in the car. A lot of patients can’t be cared for at home in any case. For example, one of the patients I recently sent to the Walnut Tree Hospital was an elderly man who had had a stroke and had been partially paralysed down one side. As it was, he could cope on his own at home, but then he caught an infection in his good leg. He couldn’t get up in the night and he couldn’t use a bottle, so I put him into hospital for 10 days to bring the infection under control. In future, he couldn’t be cared for at home; he would have to go to the West Suffolk Hospital in Bury St Edmunds.’ But the West Suffolk Hospital itself been told it is to lose 55 beds, and anyway treating elderly patients there will cost more than it now does in the local hospitals. According to a study in the journal Health & Social Care in the Community, treating a stroke patient in a community hospital costs an average of £74,000 compared with £183,000 in a district general hospital: a finding echoed in other studies.
‘But you hardly need the figures,’ says Helen Tucker of the Community Hospitals Association. ‘Common sense tells you that community hospitals are going to work out cheaper because they are heavily subsidised by local people, through leagues of friends.’ Rather than wait to be closed down, she suggests, community hospitals should consider going the way of Rye Hospital in East Sussex. ‘Ten years ago local people raised enough capital to run the hospital themselves because they didn’t trust their health authority to run services.’ It would be a mistake to romanticise cottage hospitals, however. There aren’t any left which operate from thatched cottages. In reality, many are housed in grim Victorian buildings which are disliked by many of their staff and patients. The desire to be treated and eventually die — in one’s own home is shared by many. Yet the NHS’s huge, unannounced programme of local hospital closures has nothing to do with the ideal of treatment in the home — which, if hospital standards were to be maintained, would be extremely expensive and require vast teams of travelling nurses who don’t at present exist. It is a desperate attempt by the NHS to balance its books, its salaries and its bureaucratic costs, having outswelled even Gordon Brown’s lashings of money.
Hospitals which have been paid for out of generations of benefactions and public subscriptions are being stolen from their communities to pay for armies of bureaucrats charged with overseeing failed initiatives and pointless targets. In fact, some of the targets so discriminate against small hospitals that one wonders whether they are being deliberately used in order to justify their closure. Staff at the Queen Victoria Hospital in East Grinstead, which pioneered plastic surgery on airmen wounded in the second world war, were astonished to see their hospital at the bottom of last year’s league table for MRSA infection rates. The hospital, it turns out, had just five cases, all involving patients who had caught their infections at other hospitals before they went to East Grinstead. But should there come a proposal to close or downgrade the Queen Victoria Hospital, you can be sure that its figures on MRSA will be gleefully quoted by Patricia Hewitt, the Health Secretary.
Or perhaps she won’t even bother to get involved at all in the hospital closure programme which, although it has been made inevitable by government wastage, has conveniently been subcontracted to Primary Care Trusts. As a measure of how seriously the government takes the issue of community hospitals, 2,007 citizens of Cheltenham recently signed a petition against the closure of in-patient beds at the local hospital. The petition was handed to the then Health Secretary John Reid when he visited on 15 March. A month later the petition, along with dozens of letters from patients, turned up in a skip in Oxford.
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