‘No change’ was never an option

It is the end of 12 months of controversy which will fundamentally change where thousands of people are treated each year. We look at why the changes were brought in.

WHEN the two health authorities which managed services in the Blackburn and Burnley ends of East Lancashire merged in April 2003, few would have thought a meeting like yesterday's could have happened.

As Peter Pike, the MP for Burnley from 1983 to 2005, strongly pointed out during initial discussions for the shake-up plans, managers said the merger was solely of the management of services and not services themselves.

At the time Christine Kirk, chairman of the new authority, the East Lancashire Hospitals NHS Trust, said: "I would not expect patients to notice any difference except maybe for the different signs outside the hospital. It's very much business as usual."

Fast forward to March 2006 and the managers - many of whom had joined since the merger - were faced with a very different situation.

In the meeting at Accrington Town Hall in front of a frosty audience, plans were laid out which made clear that running two general district hospitals in Blackburn and Burnley with broadly the same services was not an option.

During the ensuing consultation it was repeated mantra-like - no change is not an option.

Instead, key services such the treatment of the most serious accident and emergency cases, overnight children's care, neo-natal intensive services for critically ill babies and most pre-planned operations should be at one hospital only, they said.

The ideas had been floated the previous October, but only focused on taking away intensive care and maybe high dependency beds from Burnley General.

Yet the insinuation to anyone in the medical profession at the time was clear - bosses were moving to divide emergency and pre-planned cases between the two hospitals.

This lies at the heart of the plans.

Managers want to control when and where patients are treated as much as possible but often beds for a planned operation are taken up by a patient who is rushed in from A&E.

This often means people are put on a ward that is not right for their condition.

Bosses said by separating the two hospitals into one for emergencies and one for pre-booked care, fewer operations will be cancelled, staff rotas will be better managed and infections will fall.

Of course, this means all planned operations will have to go to Burnley from all over East Lancashire - a fact that was not forseen when the new £113million Royal Blackburn Hospital was planned from the late 1990s.

Until recently none of this would have made a difference.

The Trust would still have got its allowance from the taxpayer and, short of a massive explosion in cheap private healthcare, would have a monopoly on where people are treated.

But all that has changed. Under new Government policy hospitals only get paid for patients they treat.

If patients aren't seen, they don't get paid - the cheque is not in the post.

And patients can also choose to go to other hospitals, including the private sector, taking the payment with them. Like any business the rules are simple - if not enough people choose to go to East Lancashire's NHS hospitals then the business starts to collapse.

Health boss and Burnley GP Dr Ellis Friedman told yesterday's meeting: "If we don't do something then there are grave dangers in terms of the ability to sustain high quality services in East Lancashire."

By taking the review forward fellow NHS manager David Peat said managers were "getting ahead of the curve with all this national policy coming in".

This is against a backdrop of increased demand on hospitals as people live longer but increasingly unhealthier lives, particularly in East Lancs. Much of this must be managed by community based NHS services such as health centres, they added.

Yet managers insist the driver for change is to improve the quality of care.

They said staff are too thinly spread between Blackburn and Burnley, meaning the two A&E departments cannot be guaranteed a senior consultant at all times.

Changing this would allow doctors to improve and learn new skills, they claim.

Keeping the status quo hampers the chances of new services coming to the area in an age of massive growth in medical skills and technology, bosses have warned.

This will be made worse by the introduction of the European Working Time Directive which demands doctors work a maximum of 48 hours a week.

Managers have said doctors are hard to come by and plump for areas over East Lancashire - but even if they wanted to come, the Trust could not afford to employ them.

This is sticking point for many people - money. East Lancashire Hospitals Trust began its life with multi-million debts and since then has overspent by more than £10m.

This year it has to spend £14m less, its biggest ever savings target. To save £2.5m of this more than 20 per cent of overnight beds have been axed, as have the jobs which counted on them. Staff affected have been moved into empty posts.

The message is clear - less costs less and this is where fears have grown over the review, not least how managers allowed themselves to get into such financial problems despite record investment.

Many, though, say it is the Government which is the problem with its new rules on choice, payments to hospitals and the creeping use of the private sector on NHS money.

In Cumbria and Lancashire alone two more deals with the private sector are in the pipeline for minor surgery and tests - all of which is feared will take money away from the hospitals trust.

Bosses admit the changes will mean some people will have to travel for treatment.

Yet this has been clear from the start - East Lancashire cannot support two major general hospitals under the way the NHS is now run. No change is not an option.