| Friday, 22 September 2006 | |
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MP calls for radical re-think on the role of hospitals within the NHS Dartford MP, Dr Howard Stoate, has called for a complete rethink of the way in which hospital care is planned and managed in a new pamphlet published by the Fabian Society this week.In ‘Challenging the Citadel: Breaking the hospitals’ grip on the NHS’, the MP says that our continuing ‘obsession’ with hospitals is preventing the NHS from giving primary care the resources its needs to tackle health inequalities and become a more effective disease prevention service. “Most hospital admissions should be seen, first, as a failure of health policy,” said the MP. “The vast majority of patients enter hospitals as a direct consequence of our failure to spot the potential problem early enough, and either to prevent it or to put in place an effective care package that will enable them to stay at home.” “Every day, thousands of patients get admitted to hospital, not because they are desperately ill, or because they need the support that a hospital can provide, but because we have nowhere else to put them. This is not only a catastrophic waste of resources – a bed in a hospital for the night can cost up to two or three times the price of a room in a top London hotel – it also rarely does the patient any favours in terms of their recovery. No-one wants to be in hospital after all, and most patients will make a quicker and more complete recovery whilst in the comfort of their own homes, supported by their friends and family, rather than in the alien and uncomfortable environment of a hospital.” “Most policymakers, commentators and health professionals understand this, and will talk about the need to reduce unnecessary acute admissions and to treat more people in community settings, yet progress is painfully slow.” Dr Stoate, who is a member of the Commons Health Select Committee and a practising GP, says that the current district general hospital model, which has been in place for the last 45 years, is outdated, expensive and inefficient and in urgent need of reform. “There are a whole range of acute services that patients need to have access to - such as orthopaedics, obstetrics, trauma care and so on - but there is absolutely no reason why all of these specialties have to be provided at each and every local acute general hospital in a particular region. This duplication of services is not only very costly, it makes it more difficult for hospitals to build up certain specialties in which they have developed a particular expertise. We need a more flexible system in place that is more sensitive to the specific healthcare needs of each area.” In the pamphlet Dr Stoate is also critical of the Government’s continued support for the hospital foundation trust model. He says that this will tighten hospitals’ grip on the NHS and make it more difficult for us to achieve the aims of the recent community care white paper (which calls for a radical shift of resources and services from the hospital and into the community). It may well even lead to hospitals doing more work, not less, as they try to maximize their level of income, he argues. “Through its support of the foundation trust model the Government is making the hospital sector, already the most powerful part of the health system, more powerful still. This is incompatible with the aims of the white paper. No hospital which is able to control its own destiny after all, is going to sit idly by and watch as the services and facilities that they run - and all the income that comes from them - are transferred into the primary care sector.” In order to break the hospitals grip on the NHS, Dr Stoate has called for ‘integrated care trusts’, with responsibility for both primary and hospital services to be set up. He argues that this would break down the damaging divide between the primary care sector and the hospital sector that is stopping us from putting more resources into community based care and treating more patients closer to home. It would allow primary care doctors and specialists to work alongside each other at last in the community, and it would enable the NHS to focus more on disease prevention and on keeping people healthy. The MP also calls for a shift of nursing personnel out of hospital and into the primary care sector - suggesting that this could dramatically increase the range of preventative work and health promotional activities carried out in the community - and for a school nurse to be employed in every school. “Having a nurse in every school, would give us a unique opportunity to make a decisive difference to the way in which the next generation lives its life; putting in place an essential resource to provide young people with a structured programme of education and support on all the major public health issues facing society today such as sexual health, smoking, alcohol, drugs, diet and exercise.” “In England 25,300 schools and 8.3 million pupils share just 2,400 school nurses which equates to just 1 nurse for every 10 schools. In some parts of the country though, the situation is even worse. In Kent and Medway for example there were just 49 nurses to cover a school population of over a quarter of a million children in 2004.” “Until each and every school has its own designated school nurse, and in the case of the larger secondary schools, at least two nurses, their impact will remain a marginal one because resources will be too stretched to make enough of a difference.” |
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© 2008 Dr Howard Stoate - Member of Parliament for Dartford
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