Politics and local health care

It is a pity that our local MP, Boris Johnson has entered the local community hospital fray by opening his mouth before engaging his brain. Community hospitals are one of the reasons that our local health economy is near bankrupt—as MP David Cameron (Witney) has consistently failed to grasp. Here are a few facts to ponder:

1. Even at their peak, Oxfordshire community hospitals covered only about half the population.

2. Patients registered with GPs with access to community hospitals enjoyed more hospital bed days overall (i.e. consumed more resources) than those without access to community hospitals—and without any measurable difference in health outcomes.

3. The majority of community hospital beds are classified as ‘acute hospital beds’ nationally, i.e. the same as beds in the John Radcliffe used for acute medical emergencies. National statistics do not distinguish between the two. At their peak there were over 300 ‘acute’ hospital beds in community hospitals, and around 150 in the John Radcliffe.

4. The average length of stay for patients in community hospitals is typically 20-30 days or more; for acute medical patients in the John Radcliffe it is less than 5 days. (Yet it is the John Radcliffe that gets all the flak…)

5. Medical care for patients in community hospitals has historically been provided by GPs. Following introduction of the new GP contract, the great majority of such GPs have or are now abrogating this responsibility. To address this potentially unsafe situation, consultants from the John Radcliffe are taking on new roles in community hospitals, and Primary Care Trusts are supporting this by funding new consultant appointments.

6. The proportion of local health care funding given to community and primary care (as opposed to the major hospitals) is larger in Oxfordshire than in most other health economies.

Oxfordshire is a county renowned for its cost-of-living (and quality of life) rather than its deprivation. Unfortunately, resource allocation in the NHS—which rewards deprivation rather than cost-of-living—has worked progressively to Oxfordshire’s disadvantage for the past fifteen years or so. Community hospitals have, in short, been an inefficiently-run luxury that we can no longer afford in their present form.

In a mixed rural-urban economy such as Oxfordshire it is entirely reasonable to provide health care as close as possible to the patient, and local ‘cottage’ hospitals are an enormously attractive, if somewhat nostalgic concept. However, modern society demands higher standards and has much greater expectations of its health care systems, and providing inpatient care in small isolated units is no longer cost-effective or safe, except at the most basic level of care—a level that is often better provided in the home.

If the Tory party wants us to take it seriously, it needs to leave this outmoded and unaffordable concept in the previous century—where it belongs—and stop using it as a party political football.

Posted by Chris Bunch at September 28, 2004 08:08 AM