Are our hospitals safe in their hands?

DOCTOR Richard Taylor is very proud of what his small independent party has achieved. Since his sensational victory at the 2001 general election on a "save our hospital" ticket, the MP for Wyre Valley, in the Midlands, believes that smaller UK hospitals have more chance of survival.

But he is under no illusions that hospitals all over the country, including the North-East, are going to have to change in order to survive in the years to come, regardless of what voters are being told in the run up to Thursday's Hartlepool by-election

And while he believes few hospitals will actually close - after what he sees as a recent change of heart by the Government - he has an unpalatable message for the people of Hartlepool.

Despite virtually every candidate in the forthcoming by-election promising to safeguard services at the University Hospital of Hartlepool, Dr Taylor says voters should be sceptical.

The reality is that such changes are unavoidable if smaller hospitals are to have a future, because of changes in modern medicine and working practices, argues Dr Taylor. This scepticism seems justified if voters consider what was being said about the future of hospitals on Teesside earlier this year

A major review of hospital services on Teesside - which was put on hold by next Thursday's by-election caused by the resignation of Peter Mandelson - recently concluded that retaining full-service district general hospitals at Hartlepool, Stockton (North Tees) and Middlesbrough (James Cook) was "unrealistic".

That same review concluded that one of the options was to close the 1970s-era hospitals at Hartlepool and North Tees and build a new hospital to serve the population north of the River Tees.

Another option would be to downgrade Hartlepool hospital to a centre for outpatient treatment and non-acute surgery and concentrate acute services, including accident and emergency, at North Tees hospital.

THE outcry in Hartlepool over the potential loss or downgrading of their hospital led to thousands signing a petition calling for services to remain where they are. It has also put the future of the hospital at the centre of the by-election war of wards.

It was a sign of how serious the Government takes the issue when Health Secretary John Reid intervened last month.

Dr Reid asked top surgeon Professor Ara Darzi to work with North-East health officials to try to safeguard the fullest possible range of services at Hartlepool, including accident and emergency services and a consultant-led maternity unit, two areas previously said to be at risk.

During an electioneering visit to Hartlepool last week, Dr Reid went even further, bluntly declaring that the hospitals would not close "as long as I am Secretary of State".

But the champion of Kidderminster hospital is not convinced by the rhetoric coming from all the parties. "People have to be realistic," says Dr Taylor.

"Because of greater specialisation, because of limits to junior doctor hours, because of training difficulties, three all-singing, all-dancing hospitals cannot be preserved in your neck of the woods."

Rather than backing calls for Hartlepool hospital to stay exactly as it is, Dr Taylor advises local voters to accept that some pooling of health services is likely to happen because of national trends in medicine.

"The people of Hartlepool should be fighting for a sharing of services rather than the complete robbery that we saw in Kidderminster, so that people travel to them from the other places as well as in the opposite direction."

According to the former hospital consultant, since his electoral triumph no district general hospital in England has received the same cavalier treatment as his local hospital.

IT was the decision to strip Kidderminster hospital of its 24-hour accident and emergency department and most acute surgery that goaded Dr Taylor to stand for the Wyre Forest seat in the Midlands as an independent "Health Concern" candidate.

Sensationally, the retired consultant overturned a Labour majority of 7,000 and unseated a minister, David Lock.

But despite his headline-grabbing victory he has made little progress in safeguarding services at his local hospital.

While he has persuaded local health officials to re-open 20 surgical beds and some other services are due to return, the accident and emergency department has been replaced by a doctor-free minor injuries unit staffed by nurses.

"Our acute services have moved 18 miles away from the town but we also serve a large rural area which means some people are up to 35 miles from their nearest A and E unit, which is unacceptable," says Dr Taylor.

But the unlikely MP, who now sits on the House of Commons Health Select Committee, believes he has changed the mindset within Government towards smaller district general hospitals by highlighting their vulnerability to populist revolts.

"They are dead scared of anything like Kidderminster ever happening again," says Dr Taylor.

He points to the publication of a document by the Government in February 2003 as a major breakthrough. Called Keeping The NHS Local: A New Direction Of Travel, it prompted a new debate on the viability of smaller district general hospitals.

Dr Taylor believes that the report's conclusions, which were published in July, vindicate his own party's cause and helps safeguard hospitals all over Britain.

"We have benefited everybody else, we made the Government produce this report which we could have written ourselves," he says.

"The document published this summer is absolutely crucial, it draws attention to several models of downgrading which manage to retain a lot of services in the peripheral hospitals."

For Dr Taylor, the key quotes from conclusions to Keeping The NHS Local are:

"Keeping the NHS Local is now the core guidance to be followed by all health services planning change... it sets out to give local health services and their users encouragement in developing imaginative, innovative approaches to providing the high quality, locally accessible health care that people have a right to expect."

Dr Taylor says it is also significant that the report explicitly states that the "key message" is that patients can be safely cared for in small hospitals without surgeons on site to carry out emergency operations.

Another important passage, according to Dr Taylor, reads: "Evidence from research does not support any general presumption that large hospitals benefit from economies of scale or that service concentration leads to improved outcomes for patients."

THE involvement of Prof Darzi in the currently suspended Tees service review may sound alarm bells in some parts of the North-East.

Many people living in the Bishop Auckland area felt angry that their local hospital had been downgraded as a result of recommendations made by Prof Darzi during a reorganisation of County Durham hospitals a few years ago.

The changes mean that most acute surgery is carried out in neighbouring hospitals in Durham City and Darlington, while Bishop Auckland is earmarked as a centre for planned surgery.

But Dr Taylor says a combination of factors, including the doctor shortages, the impact of junior doctors working fewer hours and the growing trends for patients with more complex needs to be seen in more specialised units, means the new arrangement in County Durham is a sign of things to come in the NHS.

"People in Bishop Auckland should look at what happened in Worcestershire and they wouldn't be bitter, they would be delighted," says Dr Taylor, who points to the survival of the Bishop Auckland hospital's accident and emergency unit as a sign that the tide may be turning. But ultimately, it is up to the electors of Hartlepool to decide who to believe.