So are Cottage Hospital beds safe, or not ?

If a week is a long time in politics, it seems that two and a half weeks is a positive age in the management of the NHS.

That's how long ago a statement by the new Cumbria-wide Primary Care Trust (PCT) at a public meeting in Carlisle was interpreted as meaning that the nine threatened community hospitals in Cumbria, such as Millom Community Hospital and Keswick Hospital (Mary Hewetson Cottage Hospital) were safe.

I was rather sceptical of this: the PCT was certainly making sympathetic noises to the effect that Community Hospitals are part of the solution, not part of the problem. However, they also made very clear that the Community hospitals will not necessarily be offering the same services in the future that they offer today.

This week Sue Page, the Chief Executive of the PCT, told a board meeting this week that Cottage Hospitals in Cumbria will not necessarily have the same number of beds.

There is an insoluble problem here. You cannot pickle a public service in aspic, least of all one as complex as the NHS, and expect it to adapt to changing needs and circumstances. But people are right to be very cautious that proposals for change may in practice mean that some services are taken away.

If we could operate hospital beds with complete efficiency, it may very well be that we could provide a good NHS service with fewer beds than there are now. But unfortuately, we are not living in a perfect world. When any proposals for new hospitals or changes to existing ones are assessed, we need to provide the number of beds which will be required given the efficiency with which an NHS staffed by mortal human beings can reasonably be expected to acheive in practice - not the number which would be needed if the health service were perfectly managed.

Operations cancelled at West Cumberland Hospital

A number of patients expecting elective surgery at West Cumberland Hospital in Whitehaven for non life-threatening conditions had their operations cancelled on Monday or Tuesday this week because of a higher than normal number of emergency admission.

All emergency admissions were dealt with, as were all planned operations for cancer and life-threatening conditions.

The North Cumbria Acute Hospitals Trust denied allegations that the cancellations were partly because the number of hospital beds have been reduced over the past 18 months.

Hospital Acquired Infections

Figures released today show an increase in the number of deaths attributed to two types of infection which are often acquired in hospital, one of them being MRSA. Between them these two diseases alone were mentioned on more than 3,000 death certificates in 2005.

I cringed when I heard the view attributed to health minister Lord Hunt on the BBC that this increase in deaths was due to a higher emphasis on the problem resulting in better statistics.

The fact that this complacent explanation is impossible to disprove makes it more rather than less dangerous. Yes, it is possible that changes in the way statistics are recorded and collected can mean that an apparent increase in a problem is overstated or even entirely artificial. But by the same token, if the previous statistics were unreliable we cannot be certain that there was no increase. We can be certain that the number of deaths from diseases like MRSA is too high and that complacency is entirely inappropriate

Don't forget the CATS consultation

All the public meetings in Cumbria for the CATS consultation have now taken place. However, the consultation continues until 9th March. If you care about your hospitals, have your say.

The CATS consultation document is available on the internet at

www.cumbriaandlancashirecats.nhs.uk


Reponses to the consultation should be submitted by 5pm on 9th March. They can be sent in online by visiting the above consultation website, or by post to

Freepost RRHA-BEGG-LSLE
CATS public consultation
Room 3 Preston Business Centre
Watling Street Road
Fulwood, Preston
PR2 8DY.

If you care about the hospital services at West Cumberland hospital in Whitehaven, Millom Community Hospital, or Mary Hewetson Cottage Hospital in Keswick, this affects you.

Hospital petition

Conservatives in Copeland are collecting signatures on the following petition to support our hospital services and express concern about the CATS proposals.


"WE THE UNDERSIGNED,

· Insist that District General Hospital services, including maternity, Accident and Emergency, Orthopaedics, and Paediatrics, must continue to be provided in Copeland

· Note that the great majority of local clinicians and NHS managers believe that the government’s CATS contract, if imposed in its original form, could result in service closures in West Cumbria

· Call on the Department of Health, Strategic Health Authority, and PCT not to impose the CATS model on Cumbria either in its original form or any other variant which is likely to reduce either Acute or Community hospital provision in West Cumbria or elsewhere in the county."


This petition is not entirely dissimilar to one set up by local doctors which has had 10,000 signatures already, and is meant to complement and support the doctors' campaign.

The CATS proposals - this stands for "Clinical Assessment, Treatment, and Support" - would involve a number of diagnostic assessment and treatment centres which are part of and paid for by the NHS but also involve the private sector. The initial proposals are based on a standard national contract. Unfortunately the national model does not look right for Cumbria - the Chief Exec of the Acute Services trust has said that if implemented in the wrong way (e.g. in as per the initial proposals) CATS could "decimate" hospitals in Cumbria.

If you would like to support this petition, or would like me to send you a paper copy on which to collect signatures, please post a comment here or send me an email at chris4copeland@btinternet.com

Don't celebrate too soon !

I was, of course, very pleased to hear senior officials of the new Cumbria Primary Care Trust say at they Keswick public meeting that they want to keep all the Community Hospitals in Cumbria. They very clearly distanced themselve from the policy of the previous North Cumbria PCT, which had considered the possibility of taking beds away from these hospitals, or even closures, to save money.

I gather that an even stronger statement in support of Community Hospitals was given by the PCT at the Carlisle public meeting this Monday. This has been taken in many quarters as an indication that the Community hospitals in Cumbria are now safe.

Obviously it is good news that we now appear to have people in leadership positions in the local NHS who more clearly appreciate that the Community Hospitals are part of the solution, not part of the problem.

However, this does not mean that those who value our hospital services can afford to take our eye off the ball. After the positive statement in support of community hospitals, the PCT speaker qualified it by saying that the services provided by community hospitals in the future would not necessarily be the same as they provide at the moment.

The trouble with this kind of statement is that while it is obviously and inevitably true, it could be used to describe changes which might be good or very bad. I have lost count of the number of times that someone begins by saying that we need a "world class service," continues with the arguement that this means that we need to change, and then produces a set of proposed changes which look like a worse service, not a better one.

I'm quite prepared to take the statements by the PCT that they want to retain and make more use of community hospitals at face value. However, this does not mean that changes in the way they operate and the services they provide will not come forward. When that happens, residents who care about the NHS will still need to look carefully at what is proposed.

Feedback from Keswick NHS meeting

Another day, another NHS meeting, another group of local residents who are concerned about the way the government is forcing through the CATS proposals, another group of people on the platform who are supposed to be selling the proposals but are barely trying to hide the fact that they themselves have serious reservations about them.

I attended both the Whitehaven meeting on Thursday night and the Keswick meeting on Friday night because I thought the discussion at the two evenings was likely to bring out different implications of the CATS proposals and I wanted to hear both. Residents of West Cumbria are desperately worried about the future of our Acute hospital services and the West Cumberland Hospital, and as I expected, the debate in Whitehaven was dominated by the likely knock-on effect of CATS on Acute services.

Keswick has the Mary Hewetson Cottage Hospital (usually just referred to as Keswick hospital) so I anticipated that Friday night's meeting in Keswick would be a good place to hear disussion about the possible knock on effects of the CATS proposals on Community hospitals like the ones in Keswick, Millom, The Red House in Harpenden, etc.

The tone of the two meetings could not have been more different, but the underlying concerns were the same. In Whitehaven, local residents are very angry indeed at yet another threat to their hospital, which they see as undergoing death by a thousand cuts. The tone of the meeting at certain points amounted to barely controlled fury.

The tone of the meeting in Keswick was much calmer, and residents did not show their concern for the NHS in the same way, but they showed it all the same. There were indeed questions about Keswick hospital and other community hospitals. Not surprisingly, since Keswick is a long way from any of the three proposed CATS sites in Cumbria, people were very concerned about the travel times.

I have never been at a consultation meeting at which the people who were supposed to be selling a proposal were as open about the fact that they disagreed with aspects of it as on both Thursday and Friday night. This particularly applies to the comments made last night about travel time to hospitals and CATS centres, where everyone basically agreed that the assumptions in the consultation are complete rubbish.

Speakers from the Chairman of the Primary Care Trust down admitted that the time to get from many parts of Cumbria to existing or proposed NHS facilities by car are completely unrealistic, by public transport even more so, and that the proposals are nowhere near meeting their own travel time criteria.

However, the concerns to which local NHS managers and doctors admitted went way beyond travel time. In the presentation of the government's CATS proposals the speaker presenting them, Peter Clarke, included an admission along the following lines -

In Cumbria we believe it would be possible if it wasn't correctly handled for CATS to lead to service closures. The PCT is working to ensure that this does not happen.

(I've not put this in quotation marks because I'm not a trained shorthand copyist and I may not have this word for word correct but I am certain that this was the sense of what was said.)

I think it is a great shame that the govenment is trying to impose a "one size fits all" CATS model on the country. It is quite possible that CATS may have benefits in some areas - it is also quote obvious that the model which may work in London and some densely populated areas will not work in Cumbria. But as "NHS Blog Doctor" posted yesterday, this government does not ask. It tells.

There were issues raised at both meetings which involved political leadership. It is therefore a great pity that neither Jamie Reed MP nor Tony Cunningham MP were able to attend either meeting.

A Doctor's response to Blair's NHS Interview

The following thoughts on the Prime Minister’s discussion on the NHS yesterday morning were posted on his blog by a doctor.

I thought these were worth repeating here

You can read him at "NHS Blog Doctor" - the URL for the post is

http://nhsblogdoc.blogspot.com/2007/02/its-not-difficult-mr-blair.html


Tony Blair has defended his record on the NHS, and said it was in much better shape than when he came to office.

* [Not true. It is worse than it has ever been at any time in my medical career. Some waiting lists are shorter. I cannot think of anything else that is better, but could give you an endless list of things that are worse]

He defended big pay rises for GPs, and said he was pleased NHS staff were now earning more.

* [I am happy to earn more money. I am earning more money. Sadly, I am earning it for being an environmental statistician, for hitting government targets. This money has been wasted. We have worked very hard to hit targets. We should have been seeing patients]

Mr Blair also dismissed criticism his government had thrown money at the NHS without putting reform in place first. He said reform and extra cash for the NHS had gone hand in hand.

* [There have been lots of reforms. Lots of new bureaucracy. Lots of management consultants. Little has been achieved.]

On pay, Mr Blair dismissed criticism that GP pay had soared at the same time as their out-of-hours commitments had been reduced.

* [Two statements of fact. We have had substantial pay rises, and no GP now has to do out-of-hours work. A fair number work for co-operatives but no one has too.]

Earlier this week, one of the GPs who negotiated the pay deal for family doctors admitted the British Medical Association was stunned at the generous terms of the deal they were offered by government.

* [Absolutely true. I can remember when we were told that we could contract out of on-call work for a 6% cut in pay. We had a meeting. We did not laugh like Dr Fradd. We did not believe it. We would have accepted a 25% pay cut to be relieved of this onerous burden.]

Mr Blair denied that GPs were doing less, and said they were now offering a much better quality of service for patients.

* [Half correct. We are doing less in terms of out-of-hours work, much less. We are also doing more work within normal working hours, but the additional work is of little value to patients]

But shadow health secretary Andrew Lansley said the government had wasted money in the health service and alienated health professionals.

"The things like government top down target have distorted clinical priorities, wasting money and means that the professionals in the NHS are not able... to take decisions."

* [Absolutely correct. However much money we have earned, I cannot remember a political administration that is more hated than this one. And I say that as someone who voted for them. We have become wage-slaves with no professional autonomy. It is heartbreaking to see health-care deteriorate and be powerless to act. ]

Professor Alan Maynard, a health economics expert at York University, added the pay rises GPs have received - since the 2004 contract came in, earnings have pushed through the £100,000 barrier - have contributed to NHS deficits.

* [Of course they have. That is not rocket science. But the percentage of the total NHS spend that has gone on GP pay increases is small, and is dwarfed by the money wasted on PFI and management consultants.]

What should the government do to improve health care in general practice? The answer is so simple, is so clear, that only a politician blinded by doctrine could miss it. Ask patients what they want. I do not have to ask them. I know what they want. I have said it many times before.

Patients want reasonable access to a doctor. That is all. Quite simple. They do not want a phone call from a nurse-specialist, or an EMT or any other “health care professional”. They want to see, or at least speak to, a doctor. Yes, patient demands are, in the extreme, unreasonable and unaffordable. Some patients want to be able to see a doctor at any time of the day or night for any condition however trivial. That cannot be achieved. But that does not mean that we can do nothing. We could go a long way to meet patients’ reasonable requirements, and certainly a lot further than we go at present.

So here is the Crippen “back of envelope” plan for improving primary health care. Scrap all the targets. Use the money to pay incentives to GPs who provide wide availability.

a “before work” surgery from 7.00 am to 9.00 am
an “after work” surgery from 7.00 pm to 9.00 pm
a lunchtime surgery from 12.00 to 2.00 pm.
surgeries on Saturday and Sunday through-out the day
I used to run a large co-operative. A huge number of the out-of-hours calls were generated because “I could not get an appointment with my doctor”. It is the same with visits to A/E departments.

Let the money follow the patient. Allow patients to change doctor immediately, without all the bureaucratic hindrance that currently exists. The GPs providing a poor service will be poorly paid, and vice versa. That is how it should be.

GPs will not do any of this “for free”. Why should they? They have families as well. But pay them a decent amount of money to do it, and it will happen overnight. I would have no problem working my share of weekends. Nor would my partners. And it would be more helpful than recording the cholesterol levels of 87 year old women in the local nursing home.

All the government had to do was ask the profession, and the patients, what was wanted. But this government does not ask. It tells.

Tonight's public meeting moved

The venue for tonight's NHS consultation meeting in Keswick has been moved to Keswick School, Vicarage Hill, at 7pm.

This appears to have been a last minute move so that the meeting can be held in a larger room. If the attendance at last night's meeting in Whitehaven is anything to go by, that may be very necessary.

If you want to tell the Primary Care Trust how much you value Mary Hewetson Cottage Hospital in Keswick, or indeed any of the other hospitals in Cumbria which are under threat, come along and have your say.

CATS proposals criticised at public meeting

Government proposals for CATS centres in Cumbria were given a rough ride by hundreds of local residents in Whitehaven this evening at a public meeting - and by the NHS officials who were there to explain them.

The CATS proposals - this stands for "Clinical Assessment, Treatment, and Support" - would involve a number of diagnostic assessment and treatment centres which are part of and paid for by the NHS but also involve the private sector. The initial proposals are based on a standard national contract.

A major consultaion is underway about these proposals: the Department of Health appears to have laid down that they are committed to the principle of CATS but that the consultation can cover where the CATS centres should be and what services are in them. The Cumbria proposals on the table involve CATS centres at Carlisle, Workington, and Ulverston.

The British Medical Association has expressed concern that the CATS policy might have serious knock-on consequences for hospital services by taking services and away from hospitals. It rapidly became apparent this evening that most of the people who are carrying out the consultation are largely in sympathy with those concerns.

Marie Burnham, Chief Executive of the North Cumbria Acute Hospitals Trust said that her initial reaction to the proposals was that they would mean the loss of one of her hospitals. She said that the CATS centres as initially proposed would cost about £35 million a year to run: West Cumberland Hospital costs about £60 million. Later in the meeting she waved the consultation document and said "We don't want CATS as specified in this document, it would decimate hospitals."

She added, however, that a modified version of the CATS proposals might avoid these problems and have benefits for patients: both Marie Burnham and Sue Page said they were committed to finding a form of CATS which did not harm existing hospitals - they appeared to be suggesting this might involve and arrangements in which the CATS handled mainly those services where it may be difficult to provide them to an adequate standard from the acute hospitals.

The audience made it crystal clear that their first priority was the need to protect acute hospital services in West Cumbria, and that they are very concerned about the future of our hospitals. Speaker after speaker made clear that they saw CATS as at best irrelevant and at worst a threat to our hospitals.

This debate is going to run and run: if you care about your NHS, please make sure you take part in the debate and send in your comments.

Public meeting in Keswick, Friday 2nd February

The next stage of the "Great Debate" on health in Cumbria is tomorrow evening at Crosthwaite Parish Rooms, Main Street, Keswick at 7pm.

This will cover the CATS proposals (this stands for "Clinical Assessment, Treatment and Support") which were torn to shreds by the public at Whitehaven this evening, but there will also be it is also your opportunity to comment on general health issues, including the future of Community hospitals.

So if you are a Keswick resident and have concerns about the need to support Mary Hewetson Cottage Hospital, or have a view either for or against the CATS proposals, this is your opportunity to make your concerns and issues known.

This is part of a major consultation on Health in both Cumbria and Lancashire: further public meetings in Cumbria will be held at the following venues, all starting at 7pm:

* Carlisle, Monday 5th February, Denton Holme Community Centre

* Workington, Thursday 8th February, The Oval Centre

* Barrow, Monday 12th February, Forum 28, at 28 Duke Street

* Penrith, Tuesday 13th February, St Andrew's Parish Centre

* Kendal, Wednesday 14th February, Riverside Hotel.

Details of the public meetings in Lancashire can be found at the Lancashire Primary Care Trust website.

The CATS consultation document is available on the internet at

www.cumbriaandlancashirecats.nhs.uk


Reponses to the consultation should be submitted by 5pm on 9th March. They can be sent in online by visiting the above consultation website, or by post to

Freepost RRHA-BEGG-LSLE
CATS public consultation
Room 3 Preston Business Centre
Watling Street Road
Fulwood, Preston
PR2 8DY.

Today's meeting: Come and have your say on Cumbrian Hospital services

Reminder - 7pm today, the Civic Hall, Whitehaven - public meeting to discuss the CATS proposals which also provides an opportunity for comment on general issues affecting the NHS in Cumbria.


This consultation is YOUR opportunity to let Marie Burnham and Sue Page know how strongly you want to protect local hospital services at the West Cumberland, Millom Community Hospital, and Mary Hewetson Cottage Hospital in Keswick.

There is another public meeting tomorrow in Keswick at the Crosthwaite Parish Rooms, Main Street, Keswick.

Save West Cumberland Hospital

Do you want to Save West Cumberland Hospital ?

Do you want to Save Millom Community Hospital ?

Do you want to Save Mary Hewetson Cottage Hospital in Keswick ?

Do you want to Save Our Services ?

Then come along to this evening's public meeting and say so.

Public meeting tomorrow on health in West Cumbria

There is a public meeting tomorrow (1st February) on health issues in West Cumbria

The meeting is to be held in Whitehaven Civic Hall at 7pm. It has been organised by the local NHS trusts to discuss the controversial proposals for CATS (Clinical Assessment Trust and Suport Centres) but will also provide an opportunity to consider general health issues.

The meeting is expected to be attended both by Marie Burnham, Cheif Exec of the North Cumbria Acute Hospitals trust, and by Sue Page of the new Cumbria wide PCT.

I hope as many as possible of the 4,000 people who recently took part in the "Save our services" march will turn up to let the trusts know how strongly we want to keep our hospital services.