By Ian Gilbert, Leader of the Labour Group on Southend Council
The ‘Sustainability and Transformation Partnership’ proposals for moving a range of important health services away from Southend Hospital reached a conclusion a few days ago. In an unprecedented step, councillors from all parties overwhelmingly backed the Labour motion (seconded by Leigh Lib Dem Carole Mulroney) to use our statutory powers to reject these proposals and refer them to the Secretary of State. Rarely in Council is officers’ advice completely rejected and a whole new option drawn up by councillors, yet my colleague Charles Willis of Westborough Ward drew up a new formal proposal setting out grounds for referral, which then attracted all-party support.
The first immediate cause of the rejection of the STP by local councillors was the feasibility or otherwise of hundreds of extra journeys being made by unwell patients between hospital sites. Accidents and traffic jams in and out of Southend are a fact of life that we’re all well aware of. The East of England Ambulance service is already massively overstretched. Should we rely on private ambulances? At what cost, and with what security? The detail of how many patients would travel and who would be doing the transporting has remained totally unclear throughout the process. All other proposed changes rest on the feasibility of transport arrangements.
The second key issue was the future of the Stroke Unit in Southend, which is already excellent and for which the public in Southend has raised funds for key equipment. No councillor of any party has to my knowledge ever thought that moving this unit out of Southend would be in the interests of the residents that we represent.
These are important and serious issues, yet there are others. It’s worth stressing that STPs are only meant to be 5 year plans. They are temporary fixes to balance the books. People are entitled to ask whether a huge reorganisation that would take several years to fully implement should actually take into account future demand over a longer time period.
Severe problems in terms of workforce planning and lack of investment in Primary Care would be faced with or without the STP, but councillors have seen little evidence that the changes would deliver significant improvements in the timescales envisaged. Plans floated to downgrade Southend Hospital’s A&E last summer have poisoned the atmosphere between health service managers, the public and we elected representatives. We are driven to wonder whether Southend would really have a General Hospital left. A crazy situation for a large and growing town with our needs.
The government will tell you that healthcare spending is rising. This may be true in absolute terms, but is meaningless without taking into account rising population and rising cost. The drastic cuts to adult social care and to public health budgets must also be taken into account as these add to pressure on the whole system.
The fact is we are spending a smaller proportion of our national wealth on healthcare than we did in 2010, and it shows.
Cuts to budgets are only part of the story however. The government was warned by doctors, nurses, professional bodies, politicians and experts of all types that the Health & Social Care Act would cause chaos. And chaos it has certainly caused. The far from perfect but relatively simple system where local health services were run by Primary Care Trusts responsible to Strategic Health Authorities has been replaced with a spiders’ web of CCGs, Clinical Senates, and ‘NHS outposts’. New bodies such as the Care Quality Commission, the National Institute of Clinical Excellence, Public Health England and goodness knows what else have been conjured into existence.
Anyone who knew anything about health services would express the view that integration was the key to better health services. Getting the NHS and care providers to work together in a more coherent way would improve services. Instead the Conservatives imposed a system that deliberately fragmented health governance to the point where no lay person has a clue who does what. A cynic would say they did so in order to the open the way to competition and ultimately privatisation. Regardless of whether you believe that, the fragmentation of health governance is a fact.
The government, having created a system where no strategic body had the ability to reconfigure health services strategically over a wide area, then decided it was going to be necessary to reconfigure health services strategically over wide areas.
The woefully misnamed ‘Success Regimes’ and then the dreaded STPs have been overlaid on local governance, to impose top-down solutions unaccountable to local people. Given that local people feel baffled and unengaged with the process of developing and improving our local health services, it is fitting that the responsibility for the serious healthcare problems we face is returned to the only person ultimately responsible – the Secretary of State.