Professor Mascie-Taylor is right to raise concerns about the
element of US and Them rivalry that is now apparent in the responses to the TSA
proposals.
If we look at some of the History of Hospital Mergers in the
USA, which were all sparked by the drive towards centralised care, then it is
clear that solutions which look perfectly sensible on an accountants spread
sheet have a way of looking different when imposed on communities that have
different histories and cultures and also have the natural level of rivalry
that exists between neighbouring towns. Professor Mascie-Taylor drew fire for
using the word “Tribal”, but it is a word that fits. It is what communities
that feel under threat will naturally do.
The TSA process here has suffered from being the first in
this country. The TSA have followed their brief to focus on the commercial and
confidential process of finding “service providers” and I think they may
reflect with hindsight that more could have been done to involve the staff, and
to encourage the community to be a positive part of building a solution.
Sir Hugo understandably feels bruised by some of the heated
response to the best efforts of the TSA, but if we are to work through this
difficult part of the process and build a solid future for the health service
in our communities it is important that he should understand why people are not
willing to meekly accept that he is doing “what is best for them”.
The TSA process comes at the end of years of outside experts
coming in to solve our problems. Many of these processes have had the
unintended consequences of making matters worse. We are more than a little
battle weary. The biggest problem that we have to deal with, as Sir Hugo
correctly identifies, is the reputational damage to the hospital and the
increased costs and decreased income that follow that damage.
The people of Stafford have always had their doubts about
how fair this reputational damage may be, and as each new national report
studies hospitals throughout the country this doubt is strengthened. The Keogh report in particular has shown that
small geographically isolated hospitals are struggling to meet the essentially political
requirement for “financial sustainability” and may also struggle to recruit the
skilled staff they need to perform some of the more complex medical processes. We
are much clearer now that this is a real problem for small hospitals, and that
is one reason why the solution for Mid Staffs matters nationally. Many people
feel that this is an issue that requires national debate, and are concerned by
the way in which downgrades all over the country are being hidden as “local
issues”.
There is a largely unseen battle going on about what the
future of the health service should look like. And Mid Staffs plays a central
role in this.
There are many people who are alive now because the way in
which medical skills, technology and drugs have developed with such speed over
the last half century. Many people rightly see this as valuable and this drives
them towards the idea of specialised super hospitals, which are hugely
expensive and therefore have to be centralised. With this “Biomedical” model of
the health service staff and patients need to fit the requirements of the
health industry, and the health business. The TSA proposals have in fairness
gone out of their way to minimise the negative effects of centralisation by
ensuring that staff rotate between the networked hospitals and that as much
care as possible remains in Stafford. Making this work will be a complex and
difficult matter, and crucially it requires the good will of staff who will need
to work together in new larger teams.
There is also a great deal of discussion and agreement about
“Integration”, which really acknowledges that the technical wizardry that can
be performed in acute hospitals is just a small part of what a genuine Health
Service needs to do. Integration places
the acute health service within a wider picture of how do tackle preventable
health problems and how do you make acute care and community based care fit
seamlessly around the needs of the individual patients. This model which can be
loosely described as “Bio Psycho Social” is a matter for the whole community, I
saw potential support for this in the
50,000 people who marched to support the hospital at Stafford. We are at the
stage where many see “integration” as an essential way forward, but few areas
have fully effective models in place.
The idea that most people would support is that you do what
MUST be done centrally, and you do what CAN be done locally. If people of
Stafford are shown clear evidence to support moving some processes to Stoke
then I think that many can support this, especially if this is balanced by a
very clear financial commitment to recognise support and develop existing teams
that are doing very valuable work, and to make integrated care a reality.
Because the TSA process is a first time for all of us, it is
difficult to know how far the TSA is able to listen, or to modify their
proposals. I hope that that they will be able to do enough to allow the
communities to support the final proposals and that they will also spend a lot
of time and effort on assisting the staff and the communities to work together
through the many difficult and emotive issues that face us all.
Our health service is a pact between the community and the
staff who are willing to do this work. What the staff need most of all now is
certainty. It is in all our interests to find a way to make this work.
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