Are England’s small specialist hospitals becoming an endangered species?


In the first of a new series of dispatches from the frontline of England's National Health Service, published in association with 38 Degrees, Professor George Odam paints a worrying picture of the future of small specialist hospitals in the UK - and the limits of the "Foundation Trust" model.

George Odam
27 June 2013
Bath, June 2012

Few people think of Bath as an international hub of medical innovation. But it is. The medical discipline of rheumatology was first established at the Royal National Hospital for Rheumatic Diseases (RNHRD) in Bath in the 1940s. First opened in 1742, it was then known as the Royal Mineral Water Hospital. Still affectionately known as ‘The Min’, it is an international research centre for ankylosing spondylitis, the rare arthritic condition from which I suffer. I have been a local patient at The Min for the last 46 years, but in that time I have met patients from all parts of the UK - many of whom had inadequate or non-existent services for their conditions at home. To many, The Min is a life saver.

I was elected as a patient governor in 2005, when ‘The Min’ became the first and smallest Foundation Trust, semi-autonomous from government (a policy the British Labour government adopted from Spain). In the seven years that I held that position, the hospital’s unviable financial position became increasingly obvious. It is only a small hospital, but as a Foundation Trust, it has to maintain an administration department as large as those in bigger hospitals with more funding.  

The passage of the Health and Social Care Act in 2012 caused further problems.

Firstly, the local NHS bosses, the Primary Care Trust (PCT), which traditionally supported patients at ‘The Min’, withdrew their support in the initial period of uncertainty of implementation. Secondly the regional Strategic Health Authority (SHA) was also axed, thus its support could not be maintained. Thirdly, management structure replacing PCTs, the Clinical Commissioning Groups, were slow to get started. Although these groups are supposedly GP-led, most GPs have no knowledge of the unique services ‘The Min’ offers nationally. This created a perfect storm that further threatened this small specialist hospital.

Monitor - the body set up to regulate Foundation Trusts - intervened in 2008. Once in control they initiated a merger plan with the large local general hospital, Bath’s Royal United Hospital (RUH), who at the time were not a Foundation Trust and were in serious debt. This April the RUH failed to gain Foundation Status after receiving a very negative report from the quality regulators, the Care Quality Commission (CQC), which included criticism of its governance. It has been given one year to reapply.

While the Chief Executive of the 'Min' has continually stressed the importance of protecting patient services, no guarantees were given for the protection of the hospital itself, despite its international reputation as a training and research centre and unique services for Rheumatology. The Neuro-Rehabilitation Department has already been closed with no obvious replacement.

I finally resigned as patient governor last summer. I was frustrated by the lack of any real power for patient governors. On top of this, Monitor dominated our discussions, ignoring our input. They dismissed and appointed a new Chairman and pushed the ill-judged merger with RUH.

The HSCA promised increased voting power to patient governors, yet this has not been realised - we have no voting rights. Governors at RNHRD are continually gagged and our meetings were nearly all closed. We would be given mountains of detailed information just prior to our half-day meetings, making it impossible to digest in time. Whenever questions from Governors were answered, matters were considered approved and minuted as such - regardless of the actual opinion of the Governors. Over the years, meetings became increasingly oppressive; some governors even complained of bullying tactics. Governors could be present at Board Meetings but were not allowed to participate. Discussion was dominated by finance and immediate debt. No thought appeared to be given to longer-term or wider issues. Does this really constitute a democracy? 

The recent bad CQC reports about the RUH in contrast to the excellent ones given at the same time to RNHRD have created huge doubts in patients’ minds about the suitability of a large local general hospital acquiring a smaller national and specialist one where no guarantees about service provision were given.

I resigned as patient governor, because I came to the conclusion that it is impossible to run a small specialist hospital as a business, where the focus is on making profits for reinvestment, without severe negative effects on the services that it was created to provide. This is basis on which Foundation Trusts are run.

For me, small specialist hospitals which provide services for rare conditions for people right across the country should be protected and preserved. They provide quality integrated and research-based care very different to that of general hospitals - it is inappropriate to expect one form of institution to manage another’s services adequately.  

The government’s reforms are making small specialist hospitals an endangered species. And all the while Monitor - rather than watching out for the public - appears to have an eye only on profit.

You can help the campaign to protect the 'Min' by signing the petition, here.

You can donate to OurNHS here to help secure the project through to the 2015 general election. Thank you.


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