Mary Reid

The meeting at the Hook Centre this evening about the future of Kingston Hospital was quite an eye-opener. The Director of Nursing presented us with two main proposals - one is to apply for Foundation Hospital status, and the other is to contract out elective (that is, non-emergency) surgery to a private provider.

The interesting part of this was not the solutions that they proposed, but the reasons for wanting to take these two major steps.

The Government wants to reduce the number of District General Hospitals and replace them with larger specialist centres supported by polyclinics (which sound rather like cottage hospitals to me). This would put an enormous squeeze on places like Kingston Hospital - they will either have to expand to take on a more regional focus, or contract into polyclinics.

Everyone at the meeting agreed that we want Kingston Hospital to carry on providing services for the Borough, and for a wider catchment if necessary for its survival.

It was news to me that the amount of elective surgery is apparently dropping nationally. It seems this is the result of better drug based treatments, earlier intervention and also prevention. That must be good news from the point of view of the health of the nation.

But it puts the hospital in a difficult place. In order to train new medical staff (doctors and nurses) and give trained professionals a breadth of experience, staff do need to be involved with routine surgery as well as emergency work. So if the level of elective surgery drops too far the Hospital will not be able to recruit staff, will lose its training status, and eventually all surgery could cease.

The solution, as they see it, is to become more competitive and attract more business from a wider area.

Now I'm pretty unhappy about this market approach to medical care - and it gets worse when the Hospital tells us that the only way they can acquire the expertise to expand and market themselves to a wider area is by handing it over to an independent provider.  However, I do appreciate that the Hospital is having to take a pragmatic view about what is most likely to achieve long-term sustainability in the current political climate.

They did reassure us that the care would still be offered under the NHS, although they hope to make the private beds more profitable as well. 

In principle I'm also against offering Foundation status to hospitals - it should be quite unnecessary in a properly run National Health Service.  The reasons for Kingston Hospital proposing to do this are not quite so clear-cut. They say they want to avoid bureaucracy - but as we have seen with Foundation schools, extra layers of bureaucracy have to be added in, and there can be some loss of economies of scale.

The real reason for the application for Foundation status appears to be so they can compete with GPs who want to provide more and more services, such as diabetic care, or terminations, in their own surgeries. From the Hospital's point of view they have to win the custom in order to survive.

But where is the patient in all this? It may well be much more convenient for a diabetic to receive all the care they need in a local GP practice, rather than in a hospital.

And behind all of this I have a very real local concern.

GPs can no longer refer patients directly to specialists. They have to send a request to the Primary Care Trust, in the guise of the Kingston Clinical Assessment Service, who then decide whether they will commission the treatment. And the PCT is currently £22 million in debt. So no guesses what their role is - to act as a doorkeeper to services, driven not by need but by cost.

The Thatcherite policies of the 80s and 90s were based on the clearly false premise that a competitive market will be responsive to social need. Sadly this Labour Government has espoused this dangerous doctrine. By pitting the providers (ie hospitals and some GPs) against the commissioners (ie the PCT) all parties are forced to expend large amounts of energy, time and creativity on fighting each other.

I have huge sympathy for Kingston Hospital and wish it well - my anger is directed towards the Labour and former Conservative Governments who have adopted a competition-driven business model for what was once viewed universally as a service.