Scrutiny Response
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Campaign for Health Service Democracy Sheila Porter-Williams, 31 December, 2001 Hazel Blears MP Dear Ms Blears,
The Campaign for Health Service Democracy was formed in 1997 when my mother was contemptuously refused emergency surgery for a broken hip and there was no procedure within the hospital for reviewing or appealing against the consultant’s decision. We aim to bring about local democratic accountability of staff working in the health service and of policies applied locally. We would like to respond to the consultation. Although the Government has already modified its proposals, I understand that there is still some flexibility for further developing the arrangements. We draw on our experience in Rugby, where hospital services are provided at a local hospital managed as an outpost of University Hospitals Coventry and Warwickshire NHS Trust. Rugby hospitals lost their own Trust a few years ago and virtually closed down. When St Cross Hospital in Rugby was taken over by University Hospitals Coventry and Warwickshire NHS Trust, some services were restored by consultants based at Walsgrave Hospital in Coventry working sessions in Rugby. But the local feeling is that more hospital services should be provided locally. People living in rural parts of the Rugby district often find that the most convenient hospital providing full services is not in Coventry but in Nuneaton or Leicester or Northampton. If their consultant is in one of those hospitals, they are not allowed access to services such as pathology that are still provided at the Rugby hospital. To this extent services are arranged for the convenience of the institutions rather than the people needing to use them. The Royal Colleges push for services to be concentrated into sub-specialties at large hospitals. More and more local hospitals are likely to have the ambiguous status of the Rugby hospital, managed from afar and receiving services only to the extent that resources are surplus to the immediate needs of the larger hospital. I believe the situation in Kidderminster that led to the election of Dr Richard Taylor as MP for Wyre Forest may be similar. Arrangements for scrutiny and patient representation need to be adequate to meet the needs of communities served in this way. Recently University Hospitals Coventry and Warwickshire NHS Trust was awarded no stars and given six months to turn itself round, after it was reported that Walsgrave Hospital was cramming five beds in wards designed and equipped for four and was working pre-registration house officers beyond their contractual 56 hours per week. The Trust Chief Executive only agreed to meet councillors and CHC members about his plans to turn round the hospital on condition that the meetings were in private, using "commercial confidentiality" as the excuse. Whatever the origins of "commercial confidentiality" in relation to NHS Trusts, the concept is unacceptable when applied to public services, and should have been outlawed as part of the Government’s 1997 pledge to abolish the "internal market" in the NHS. As the NHS is making increasing use of the private sector, it should also be established beyond doubt that all matters relating to care of patients and services available to patients and the community must be open to public scrutiny, even when they are covered by commercial contracts. It is vital that the scrutiny role be performed in public. The University Hospitals Coventry and Warwickshire NHS Trust will be providing services commissioned by several Primary Care Trusts, and will be the main hospital trust serving Coventry PCT and Rugby PCT. Local authorities with an interest will include Coventry City Council, Warwickshire County Council, Rugby Borough Council, and to a lesser extent other district councils. It needs to be clear that all the relevant authorities have the scrutiny powers. Specifically Warwickshire County Council should be able to delegate its scrutiny role on University Hospitals Coventry and Warwickshire NHS Trust to Rugby Borough Council in relation to services that are or should be provided in the Rugby hospital while retaining the scrutiny role for services provided at any of the Trust’s sites for Warwickshire residents. Arrangements for patients’ forums should not disadvantage patients of remotely managed hospitals. This could either be by allowing the patient’s forum for a Primary Care Trust to delve into services commissioned by the PCT, or by establishing separate patients’ forums for hospitals providing outposted services. The former approach would be the only one able to consider adequately the implications for patients put to inconvenience or deterred from attending appointments at remote hospitals because services are no longer provided locally. Yours sincerely, Sheila Porter-Williams |
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Sheila
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