Chorley Hospital must not be fragmented into a cold-site

Fragmented services will see the demise of Chorley A&E

I've just read an article from the Health Service Journal (HSJ) promoting separating pre-planned surgery (elective) from unplanned activity A&E/Urgent care.

This is the plan the Lancashire Teaching hospitals NHS 'foundation' trust have in mind under the Our Health Our Care program - part of the governments 10 year plan to close and downgrade many hospital A&E departments thus priming elective procedures to take in private paying patients.

After all, that's what a foundation hospital was setup for, as a company that could make up to 50% of its profits from private means.

This will no doubt mean the A&E at Chorley and South Ribble hospital will close altogether leaving no emergency cover for over 200,000 people, excluding tourists and others that may need to be diverted there due to other A&Es having no beds.

I'm also being lenient on the future numbers as well, since the mid-2000s there has been an explosion of housing in the Chorley and central Lancashire area that would no doubt require accident and emergency services to prevent overflows at neighbouring A&Es.

See also: Chorley population increase warrants own A&E

Splitting elective surgery on a separate hospital site (called a cold site) from unplanned activity at a trusts other hospital (called a hot site) is a financial proposition that deals with a short-term bed-blocking and financial problem.

It is not a viable long-term solution for a growing population as seen in Central Lancashire and many of my fellow campaigners would argue that such short-sightedness will cost lives in the longer term.

As an example, take the idea of separating A&E into 2 parts: patients that present at A&E but after triage don't need emergency treatment (urgent care), and those who do (emergency care).

The A&E at Chorley has always had this urgent/emergency triage system.
However, it was almost impossible to convert such a system into a profit-making venture as all those who presented at the A&E department came under the public NHS umbrella.

What was needed was to fragment the A&E into the 2 parts thus priming the urgent care ready for privatisation.  This is what's happened at Chorley hospital, and any steps to fragment services further, such as making it a cold-site, could result in further privatisation of elective procedures. 

In fact, this is the objective of the 10 year plan and we've already had a peak of just how ugly it looks. Take a look here at the 'price-list' proposed by Warrington & Halton hospital trust who planned to charge patients up to £20,000 for treatments - previously available for free, but removed and charged for by the local Clinical Commissioning Group (CCG).

Fragmented Hot & Cold sites are a response to previous hospital and bed closures

A well managed general hospital fully staffed working well below 100% capacity wouldn't see an increase in A&E attendances as 'random intrusions' (as this HSJ article so bluntly puts it) to daily elective and outpatient services .

The sole reason for concentrating on elective pre-planned ops is they are lower risk with a higher guaranteed profit turnover, either via Pbr (Payment by results) or private patients (tending more to the latter these days).

The separation across sites also fails to recognise that staff who work in ED are also required to work in other hospital departments when A&E sees less activity.
If an elective patients' condition deteriorates they still have to be transferred to ICU anyway making it another hurdle and risk.

The model shown in the HSJ article is flawed and reaches a false economy since it suggests increasing bed capacity over the peak winter months to meet demand.

There is something inherently wrong, not with the models proposed, but with the sheer number of unpredictable A&E attendances. And that's the capacity Vs demand problem.

The HSJ article/model attempts to plan bed capacity around A&E activity which is futile due to the fact that over half the beds (and hospitals) have been cut over the last 30 years. To make it worse, successive governments have closed post-trauma/chronic support hospitals and geriatric hospitals which used to take a huge bed burden off general hospitals, including A&E.

That's where the solution lays. 

A modern hospital building program is needed to accommodate an increasing population and to replace those closed over the years. Closed by incompetent politicians who have tinkered around the edges of the NHS for their own political gains.


Related Links

HSJ article: The case for separating 'hot' and 'cold’ facilities

NHS hospital stops plan to charge patients almost £20k for operations after outcry