Henry responds

This is a long one....

Back at the start of February, I challenged Cllr Henry Smith on his Campaign 4 Pease Pottage Hospital proposals. The basic gist of it is here.

After a bit of banter on Maidenbower.org.uk (I came in around page 12) I boiled it down to seven questions. Henry finally (about a month later) has answered them.

The questions are shown in bold. Henry's answers in italics. My response is in green.

1. What are the credentials of the professionals who produced the report? (as a supplementary, can I ask whether any of them are affiliated to the Conservative Party or if they have interests in the Private Health sector?)
   
   The working group set up to consider the project included clinicians, a former senior DOH official, a retired local authority chief executive and private sector executives. The paper was drafted by Adrian Brown, a former managing Director of Tarmac plc's Management Division, which has been responsible for building, financing and running many large public sector projects including several large acute hospitals. Preliminary discussions were also held with other companies including Healthcare Projects, a healthcare company with experience of managing some of the largest new hospital projects in the NHS including Barts & The London NHS Trust, University Hospitals Coventry & Warwickshire and South Derbyshire Acute Hospitals Trust Derby. They found our proposals innovative and they assisted by modelling the travelling times for a new hospital at Pease Pottage. Discussions continue with other interested parties.
   
   Mr Brown, who also served as Chairman of the Surrey & Sussex Healthcare NHS Trust, has no affiliations with any political party, and has no interests in the Private Health sector.
   
   That addresses who Mr Brown is (I couldn't work it out from a google search). It also seems that private companies are being consulted, although I suppose we can't know too much about their involvement if it is 'commercially sensitive'.
   
   It would have been nice for C4PPH to have been up front about who authored their proposals, a list of three names at the bottom is almost meaningless.
   
   
   
2. Why has training and the issue of Royal Colleges guidelines not been addressed, particuarly as it affects the assumption on a viable catchment area?
   
   Patient numbers and throughputs need to be accurately modelled and an suitable model of care developed working closely with clinicians, other stakeholders and the Royal Colleges. This is planned as part of the second phase of the project. There is no uniform model of care suitable for every region. Of particular relevance is the BECAD model developed by the DOH and also models of care used in other European countries, especially those with lower population densities.
   
   Except, of course, that the UK has a fairly high population density, and this part of the South East is hardly desolate. It may well be appropriate to apply BECAD to areas like North Yorkshire or the Peak District, but we are not there.
   
   Of course, the short answer is 'No, but we hope that when we do, they don't completely change things, or worse still rule out our assumptions'
   
   
   
3. How exactly were the estimated figures arrived at - particularly the running costs one?
   
   Capital costs were based on the actual completion costs of two 500 bed acute hospitals in the Midlands with an adjustment applied to bring the cost base up to current costs. Frimley Park NHS Trust was used as a basis for operating costs as its scope of services is similar to those proposed, it is well run (Foundation Trust), operates from a single site and is in the south east close to a Motorway in an area of high employment and relative affluence. As a comparator, Rotherham Foundation Trust was also looked at. It is a similar hospital but located in the north east where employment levels and relative affluence can be expected to be somewhat lower. There was virtually no difference in the cost base. Both hospitals have c 700 beds so costs were adjusted accordingly.
   
   I'm pretty sure that is not the 'exactly' I asked for. It adds little more than the document provides itself, that they adjusted the figures. I wanted to know how the adjustment worked.
   
   
   
4. Are there local factors that differ between here and Camberley that might effect running costs and the viability of this plan - such as staff turnover/availability, employment base, etc?
   
   See answer to Q3.
   
   That doesn't cover the question. This area has historically poor history regarding NHS finances. There must be some root cause, and it goes back further than 1997. Before that, Crawley was threatened with closure, Horsham was downgraded. Given that the NHS will be paying the revenue bills, how can we be sure that whatever it is that is wrong won't just be continued?
   
   
   
5. Why propose private management for a major hospital including A&E? Where is a similar model already successfully employed?
   
   Why not? The private sector has been encouraged to run many aspects of public services both in the NHS and in other sectors. Diagnostic & Treatments Centres (DTCs) e.g. Redwood at East Surrey Hospital which is run and managed by BUPA delivers excellent care and value. ITCs (Independent Treatment Centres) are owned and run by the private sector to treat NHS patients. It is only suggested that this option be considered. Also suggested is that the option of a not-for-profit trust be considered to own the hospital if the conventional NHS PFI route is not followed. This will allow the substantial profits made bythe PFI providers to be used to improve patient care.
   
   There are currently no hospitals in this country where the A&E function is under private management. ITCs have so far been small, with no more than a simple 'cuts and bruises' clinic rather than a real casualty department. They also rely on elective private surgery to work profitably, and around here I suspect that there is a bit of competition for that (Gatwick Park? Redwood?). Combined with the idea that this will be pretty much a District General hospital, which will mean much of the throughput will be NHS rather than private, I wonder if this will actually be 'substantially profitable'. Of course, if the PFI / private health management company make a loss, what happens? Does the NHS (ie: John Q Taxpayer) pick up the tab? Or do services suffer?
   
   
   
6. Other than spelling mistakes, what errors in the report have been missed?
   
   The basis of the report is clearly set out.
   
   So does that mean there are no errors in it? Or tha he can't find any?
   
   
   
7. Why can't the Bagnall proposals not form the basis for a campaign?
   
   The Bagnall report provided a valuable insight into healthcare options several years ago. Healthcare has moved on since then and there is more scope for innovative thinking. We have shown how a modern hospital can be provided (albeit somewhat differently than the standard NHS model) to treat local patients. The model proposed provides state-of-the-art healthcare, a strong element of local control and management, no additional financial burden on the NHS and employment opportunities not only for the hospital itself, but for the other healthcare related facilities which it is anticipated will be attracted to the site.
   
   However, Bagnall basically concluded that the area (North Sussex & East Surrey) could only sustain one major General hospital. That's why Crispin Blunt hates it, because the top recommendation was to move that one hospital from near Redhill to near Crawley.
   
   The trends in healthcare have not altered substantially in the last 5 years, although perhaps the financing has. We knew in 2001/2 that there would be less need for people to spend a long period on a ward before and after surgery. We knew then that emergency care was more dependent upon the speed with which a paramedic could arrive on scene and what they were capable of.
   

I have to say, I don't find these answers very convincing. There is something to these proposals, but the one area that really concerns me is that they appear to have been knocked up in order to back up the campaign, rather than the other way around. As a result, the plans have not been thought through, and the proposers are still waiting for the 'next phase' before they find out whether it's actually viable from the point of view of training accreditation for medical staff.