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Articles: Lanarkshire Health United |
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Lanarkshire Health United
An Introduction LANARKSHIRE HEALTH UNITED
‘The NHS will last as long as there are folk left with the faith to fight for it’.
Aneurin Bevin,MP
Link to Monklands on Line www.monklands.co.uk
Who are we?
We are a group of trade unionists, MSPs, councillors and members of the public, who oppose the programme of closures currently being proposed by the NHS Lanarkshire Health Board in its document ‘A Picture of Health’ . We are affiliated to the Scottish Health Campaign Network, an organisation which is campaigning across Scotland for better health services.
What closures are proposed?
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The Health Board are planning to close one of the A&Es (Accident and Emergency unit) either at Hairmyres or Monklands. It is also proposing to shut a number of day hospitals and to reduce mental health services overall in the area. Continuing care beds for older people in hospitals are to be shifted into private nursing homes, and people from Kirklands hospital and Hartwood will be placed in the community, or else in a nursing home.
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Is this happening anywhere else?
Yes. Of the 15 A&E units in Scotland just now, seven are under threat of closure. These are:
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The Victoria, (Glasgow)
The Western Infirmary, (Glasgow)
Stobhill,( Glasgow)
Ayr Hospital
Dunfermline Hospital
Inverclyde Royal (Greenock)
Monklands or Hairmyres (Lanarkshire)
My MSP is campaigning for our local hospital. Why should I join your campaign for all three?
Don’t be fooled. Each MSP is campaigning for his/her own individual hospital, but they are not campaigning against the policy of closure which has been initiated by the Executive. This will enable the Executive to come in as honest broker and pick the hospitals it wants to close, without any interference. We need to campaign against the policy and we need to do that together.
How does this affect me?
A&E Services
At the moment, it is proposed that the number of A&Es in Lanarkshire be reduced from three, to two. The A&Es marked for closure are either Monklands or Hairmyres. The hospital without the A&E would then become a Level 2 hospital, providing planned surgery and beds for continuing care and rehabilitation. The favourite candidate for closure is Monklands.
Our A&E services are overstretched as it is. Last year, Hairmyres and Wishaw between them closed their doors and referred patients to Monklands 110 times. If any of these three hospitals close, the other two will be overwhelmed.
We are also affected by proposed closures in other NHS trust areas. If the Victoria A&E shuts in Glasgow, Hairmyres could see an influx of patients from the Victoria’s catchment area.
Transport is a key issue. Closure of either of the two A&Es under threat will mean that patients will have to travel further in an emergency situation. In particular, they will have to go along the A725, which has no emergency lane, and through the Shawhead flyover, which is a severe bottleneck. This journey can easily take an hour at peak times; that would mean two hours travelling for an ambulance, which has to travel to the patient’s house and then back to the hospital. People who have a stroke are going to be very vulnerable; a paramedic cannot administer clot busting drugs to a stroke patient, because it might not be a clot, but bleeding in the brain. The patient needs to get a CT scan first, which they can only get in hospital. The paramedic therefore has to get the patient to hospital as quickly as possible, before brain injury or death occurs. Stroke is one of the biggest killers in this area, and we have the highest rate of heart disease in Europe.
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Planned Surgery (surgery that is arranged by appointmnet)
The hospital that loses its A&E will become a centre for planned surgery that involves a rehabilitation stay or an overnight stay. This will include heart, bowel, orthopaedic and breast surgery.
The argument being put forward for separating A&E surgery and planned surgery, is that it will lead to less cancellations. Your surgeon will not be called off to an emergency, just as you are about to go on the table. But it’s not as good as it looks.
Things can go wrong in planned surgery. Many of these operations are on older people and even in the best circumstances, emergencies can arise. Instead of having the surgeons and consultants you need next door, you would have to be transferred to the nearest A&E hospital.
Transport again, is an issue, but this time for the visitors. Instead of a few minutes journey to your local hospital, you will be travelling several miles across Lanarkshire to visit. The visiting time that most people can make during the week is 7pm. That is the time that most bus services stop to the villages. Even on the main routes between the towns, it is still a trek. You cannot get from Wishaw to Monklands without at least one bus change. You can get one bus to East Kilbride from Monklands, but it takes an hour and 20 minutes, and that is only the timetabled duration. Car owners will find it easier, but car ownership is lower in Lanarkshire than in other parts of the country; in Motherwell only 57% have access to a car and they will be most severely hit by the planned hospital proposals.
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Care of the Elderly and Mentally Ill
There has been less publicity on these issues, but they are none the less serious for that. There are several closures and mergers proposed and they are as follows;
Closures:
Kirklands, Hartwoodhill, Airbles, Roadmeetings and Lockhart .
The following are to have continuing care dementia beds reduced:
Cleland, Hattonlea and Cumbernauld.
Older people in continuing care are going to be placed in care homes. Adults with learning disabilities from Kirklands have been placed in the community. Patients with brain damage/ psychiatric disorder from Hartwoodhill will go in nursing homes.
Mergers:
Coathill – is to take in people from the Alexander Resource Centre.
Lanark -Â a new facility, is to take in people from Roadmeetings and Lockhart; that is, continuing care, acute medical rehabilitation and terminal care.
Caird House – is to take in some people from Hartwoodhill (complex needs).
Strathclyde Hospital – will have a learning disabilities centre.
Kilbride Hospice- has fallen through. This was to be a hospice on the Hairmyres site, with specialist palliative care beds.
The Kilbride hospice Trust had saved up £1.4million to build this hospice. Despite this, the health board pulled out, saying that people preferred care at home and they would fund this instead.
The Shift to the Private Sector.
The common theme in these changes is that many people are going to be moved into the private sector. In North Lanarkshire, there are now no state run nursing homes; they are all private and this is a cause for concern.
We are at the start of a process that has been going on in England for some time.
In England, many day hospitals got closed; continuing care beds in hospitals were farmed out to nursing homes as bed shortages got more acute. In these circumstances, where an NHS patient is passed on to the private sector for care, the NHS is still meant to pay for that person’s care, where the care involved has a significant medical factor. In reality, what has been happening is that some trusts have been placing patients into nursing homes, ‘forgetting’ to tell the patient that it should be free, and leaving the patient to pay themselves. For many, this involved the sale of their house.We must ensure that does not happen here.
Why is all this happening?
The NHS in Crisis
In 1993, our government agreed to the European Working Time Directive. This stated, amongst other things, that doctors should not work more than 48 hours a week. At this point, many doctors were working 60 – 70 hours per week; there were reports of some working 100 hours per week. This was leading to mistakes and burn out in the profession.
Obviously, to reduce the number of hours, would mean that more doctors would have to be employed to meet this target. Training doctors takes time, (it takes 15 years to train a consultant) and it was agreed that the directive should not be fully implemented until 2009. However, not enough doctors were trained to meet the requirement.
At the same time, many hospital buildings were needing upgrades or completely rebuilt. In some cases this was because of new health and safety regulations. In other cases, it was because money had not been spent on the regular upkeep of the building fabric.
The Solution- PPIs and centralisation
Central government was reluctant to provide extra funding. The NHS is the single biggest expense on the national budget and they had no wish to add to its cost. Restraints were put on local NHS trusts to stay within budgets ; if they went over their budget this was registered as a ‘debt’. NHS Lanarkshire is £20 million in debt; one of the worst deficits in Scotland at the moment.
NHS trusts faced the problem therefore, of finding money and staff, while at the same time staying within budget. In order to do this they turned to the private sector for help and the PFI system.
‘PFI’ stands for ‘Private Finance Initiative’; the other variant is PPI, which is ‘Private Public Initiative’ but they are essentially the same thing.
A PFI is basically a loan. If for example, the trust wanted to build a new hospital, they would approach the private sector. The trust would provide part of the money for the build, the private sector would provide part of the money, and build the hospital. The trust would then pay back that loan with interest over a period of 30-40 years. Other elements can be tied in with that loan;Â ie lease of land that the building is on.
The real catch with PFI is; when the loan is paid off, the building does not then belong to the NHS. It belongs to the private financiers. NHS buildings and land are being effectively handed over to the private sector in this fashion. Hairmyres and Wishaw were both rebuilt using PFI; we are paying £1billion over thirty years for it, and at the end of that, we still will not own the buildings. Even worse, whatever happens to those buildings and even if they get knocked down, we are still tied into that loan. Monklands is state run; it is not PFI, and that is why it has become vulnerable to closure, because it can be closed without penalty.
Centralisation of Services.
In order to solve the staffing shortage and to comply with the European Working Time Directive, it was proposed that A&E services be ‘centralised’. This means that instead of having three A&E units with a smaller number of staff, you could have two A&E units with a bigger number of staff. Planned surgery (surgery by appointment) that had a lower risk factor and did not need the presence of a consultant to be carried out, would be transferred to the hospital without the A&E. This would take pressure off the beds, and would mean that operations would not need to be cancelled. It looks good on paper. It is not good in practice.
Things can go wrong in planned surgery.
Many planned operations are on elderly people and even simple operations can go wrong under these circumstances. In this scenario, it could mean a race against time to the nearest Level 3 hospital, instead of having the necessary staff on hand. None of us like operations being cancelled because the surgeon has been called to an emergency, but it’s just a wee bit rough to expect someone to die for our convenience.
Transport Problems
Hospitals are placed where they are, not just for reasons of population, but also for reasons of transport. A hospital has to be easily accessible by public transport and its population has to be able to reach it quickly in an emergency. Lanarkshire is peculiarly difficult in terms of getting from A to B, and the only way of solving the transport problem was to have three, not two hospitals. That is why Monklands was built. Remove an A&E from any of these three and you have an insolvable problem with regard to transport.
Paramedics are not Doctors
There is much that a paramedic can do when they reach the patient. However, there is also a great deal that they cannot do. In particular, they cannot do anything in the case of stroke except get the person to hospital as quickly as possible. This is because a stroke can be caused either by a blood clot or bleeding on the brain, and a scan needs to be done before treatment is given. If it is bleeding and the patient is given clot busting drugs, it will kill them. Sharon, the Israeli Premier, was a victim of this mistake and nearly died as a result. Stroke is one of the biggest killers in this area, and the travelling time to hospital is crucial to survival.
Can we do anything about this?
Of course we can. Here are some things that could be done to help the NHS
1. PFI buildings shouldn’t belong to the private financiers at the end of the loan period. What mortgage can you think of, where you pay for thirty years and your lender owns the building at the end of it? These are huge contracts and they could be re-negotiated by government; no business is going to walk away from a £1billion contract.
2. We have plenty of suitable candidates for training as doctors. Medical colleges are over-subscribed. Let’s train them. And we are not the only European country having difficulty with the Working Time directive. Let’s negotiate with them for more time.
3. Do we need ten managers for every doctor? That is the ratio at the moment. The number of managers in the NHS has doubled in the last ten years. Let’s get the auditors in, and find out why. We need more accountability.
The problems in the NHS are huge, but they are solvable. But we, the electorate, need to make it clear to the politicians that we are aware of the problems and that we don’t want a quick fix of cuts and closures; we want a proper restructuring of services. And we want to make it clear that the NHS is a service, not a business. We pay for that service and we expect to receive it when we need it.
News and Press Reports
We are holding a rally at the Scottish Parliament on Thursday 15th June at 11pm to coincide with First Minister’s Question Time and a petition will be handed in. There will be buses run to this event; the details of pick up points are still to be sorted. If you wish to join us, and are traveling with us by bus, we need your name and address. Contact us at the forum address.
Julie McAnulty
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