The sun was shining, the birds were singing, Monklands and Ayr got reprieved and Andy Kerr had a face like a sour meat pie. Perfect!
However, this is where the real work begins. Why Monklands and Ayr? What about the other A&Es being downgraded? Grant on Tartan Hero was asking about Stobhill. He's right. It would be madness to shut Stobhill; it acts as an overspill for the Glasgow Royal. How about St John's Livingston? Vital for accidents on the M8 and severe cases of trauma. What about the Victoria, which is being downgraded and replaced with a wee diddy ACAD posing as a hospital?
Then there's the economics. Where's the money going to come from then? We get a block grant from Westminster. Will they increase it or can we find a way of reorganising services up here that will allow things to run properly? Here's the way I look at it.
1. We have a surplus of doctors chasing specialities at the mo. It really should not be a problem getting staff, if we really want them.
2. If we stop using PFI for everything, we can save a lot of money. It would mean that hospitals would not need to employ the army of administrators, lawyers and accountants that go with being in private business. It would mean that if you have to change a lightbulb, you can do so without advertising in the European Journal for a lightbulb changer. It would mean that we would not get tied into stupid contracts like Stracathro, where the private company gets £15 million over the next 3 years, whether they do the set number of operations or not.
3 At some point, central government is going to have to bite the bullet on PFI payments and take fiscal responsibility for them, off local authorities and health boards. There's no way round it. Local authorities have been paying for these debts in kind, by selling off land and day hospitals. Now they're at general hospitals. It's got to stop here. The government should assume responsibility and do some serious re-negotiation over the contracts, especially where companies have made a fortune by re-financing and not passing on the benefit to the hospital.
4. Re- consider the position on capital charging. This is where a hospital is charged tax on the value of their buildings and land. The effect this is having, is driving hospitals out of central city sites (ie Yorkhill and the Queen Mum in the West end of Glasgow) to relocate on the periphery of civilisation (the Southern General, beside the sewage works).
Right, now that I've sorted the NHS, I'll go and bake a cake..
3 comments:
Good to see your take on it all Julie, given the long hard slog you've had in fighting this.
The sooner the NHS can wean itself away from PFI the better, but do you think there's a chance that spreading the resources across Scotland will limit our chances of having truly specialised centres of medical excellence for specific treatments?
Personally, I'm sure there's a way to have enough local hospitals and a few centralised specialisation areas. But just thought I'd ask...
Hope you enjoyed the cake!
Hi jeff,
I take your point, but what you've got to understand is that all this talk about specialisation and centralisation was nothing to do with medical excellence; it was because the European Work Time Directive was going to kick in, in 2009 and the government did not want to pay more money for more doctors, so the only alternative was to shut hospitals.
On the subject of centralisation and super hospitals, there is a McKinsey report (unfortunately it's in German, but a German friend of mine told me what it was about) on hospital sizes. It concluded that the most efficient hospital was a middle sized one; after you get beyond a certain size, it becomes too unwieldy. Staff have to get from one end of a huge building to the other, it's harder to get to know your colleages, patient transport round the hospital is more difficult and if there is an outbreak of disease, more people are going to be affected because they're all in one building instead of several spread across a geographical area. Also, a specialist can only operate on so many patients a day. There comes a point where you've actually got to train more specialists, not just shove all the patients for one particular ailment in one place. It's the government's reluctance to do this that has led to the problem. And I did enjoy the cake..
The RIE is a big hospital. It takes about five minutes to get to the canteen, and another five to get back. That's ten minutes out of a meal break of thirty minutes.
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