Your Health: Determining the future of hospitals whatever the General Election result

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If you were, would you be persuaded to carry out a stressful Easter weekend hospital night shift, by the offer of a free chocolate egg? I doubt it.

Other desperate hospitals offered enhanced pay of up to £95 per hour. So much for the efficacy of the imposed Junior Doctor contract.

Confessions of a Junior Doctor illustrates the struggles of new doctors as they try to overcome their anxieties and put their training into practice

Confessions of a Junior Doctor (C4, Wednesdays) illustrates the courageous struggles of new doctors as they try to overcome their anxieties and put their training into practice. The odds are stacked against them. There has been no staffing increase to meet increasing patient numbers. Sometimes it only takes one staff absentee to throw the system into chaos. After a few months, one third-year doctor leaves the NHS to apply for work abroad (as did around 6,000 others). He feels the system denies him the opportunity to practice good medicine. Only foreign doctors can fill the vacuum and applications from the EU have slumped.

This is how the NHS may well collapse. Staffing levels become unsafe; hospitals are put into special measures; facilities are closed; patients have to travel further and wait longer; private providers jump in to offer services. Concern about staffing levels is one of the main drivers for the overarching hospital review about to start in our region. Barnsley’s hyper-acute stroke service closed unexpectedly last year because of a lack of consultants.

Is this inevitable even under the Conservatives? Of course not as long as we fight for it! Money and better conditions for staff have to be part of the answer, though that’s not part of Theresa May’s agenda and a landslide Conservative victory is likely to bring Tory NHS privateers back into prominence. But finance isn’t the whole story. Some of it is about us, patients: what we expect, and how we behave. And some of it is about the structure of healthcare. This is a topic we are exploring in the Festival of Debate on May 4.

The C4 narration calls hospitals ‘the backbone of the NHS.’ They are the visible signs that the NHS is there for us – perhaps even more so now that access to GPs has become more difficult. When a hospital is under threat, thousands may march to save it unless there is an acceptable replacement in view as has generally been the case in Sheffield.

District General Hospitals have been under threat for years as they struggle to compete for staff and resources. Their problems are even worse now due to government insistence on big financial cuts over the next two years. There’s big pressure for centralisation, especially of specialist services, though it is not always clear whether this is driven by clinical evidence, the increasing dominance of technological medicine, economy or convenience. Meanwhile large and successful NHS Trusts are seeking to protect themselves by expansion and through vertical integration of services outside their central hospital provision.

Two approaches seem to dominate current NHS management thinking but they both overlap and contradict each other. The first is a convenient adaptation of public health arguments that pouring money into resource-hungry hospitals just ensconces the NHS as a curative, rather than a health service. If money is spent on conditions that promote health, rather than propping up hospitals; and if healthcare is delivered closer to home preferably before many needs become acute, then demand for in-patient care would diminish and require less of the expensive financial overheads of hospital care.

The second approach forms part of NHS England’s reiteration of the NHS Five Year Forward View. It involves creating care systems which reduce divisions between NHS institutions and have clear links and pathways between what is available in different hospitals and with other local services. Implications could include shared staff as well as patients being transferred between locations as their needs change. So Sheffield consultants might run clinics in other parts of the region as well as in community settings. We could also see hospital managers in charge of more community services, a leadership role for which they are not equipped. Hospitals would have to understand and model public health as well as providing acute treatment.

Current proposals for centralisation of some stroke and children’s services are the first local manifestations as South Yorkshire and Bassetlaw is fast tracked into so- called accountable care. Early this summer consultation will begin on how Urgent and Emergency Care are provided locally.

All these developments pose huge questions for our local NHS. Unfortunately most of the proffered answers are untested. A recent Nuffield Trust report, Shifting the Balance of Care, torpedoed casual assumptions about projected falls in hospital activity, accusing NHS bodies of frequently overstating the economic benefits of community-based initiatives. The future of hospitals needs to be determined in a close dialogue with us, patients and public, not on definitions of efficiency and cost ceilings which have little to do with real medicine or patient care.

Come to the Festival of Debate discussion on the future of our hospitals, at Quaker Meeting House, on Thursday May 4 at 7pm. Visit the Festival of Debate website to book or email Sheffield Save Our NHS on for details.