Godot arrives: Compton Review delivers

Last week I suggested that Northern Ireland health reform was like waiting for Godot. Now Godot has arrived, told us he is sorting out major changes and that he will be back soon.

The Compton Review (pdf) is a large and highly impressive document. Despite having been carried out in only a few months it has clearly been well researched with examples taken from best practice throughout the UK. There are twenty one chapters which detail everything from maternity to palliative care and specific mention is made of the proposed future overall model and the implications for the current service. Much is made of the need to proceed to more patient centred care and attempts to keep patients in their own homes. That sounds uncontroversial but keeping patients in their own homes would reduce the need for acute beds and acute hospitals. The relevant quote is here:

A bed utilisation audit of 2011 showed
that, on the day in question, up to 42% of
the inpatients reviewed should not have
been in hospital.

The headlines noted by the BBC, UTV and Belfast Telegraph all centre on the number of acute hospitals. The suggestion is that the number of acute hospitals be reduced from 10 to 5-7: the hospitals which are to become non acute may still have a role providing other forms of care.

The review proposes the reduction in numbers of hospitals over the next five years. It does not appear to specify its preferred number of hospitals (5, 6 or 7) nor does it specify which ones that includes. Most can work out which hospitals would be the five (Royal / City, Antrim, Altnagelvin, Craigavon, Ulster) and most health analysts have suggested that those five would be the correct ones to keep. The arguments are clearly going to be whether there should be another two and if so which ones: the most likely would probably be Erne and Causeway (in that order of likelihood of survival). Politicians will no doubt acquiesce to the closure of any hospital apart from the one in their own constituency, which in contrast they will fight for tooth and nail.

When the Compton review team went to the Health Committee a large amount of the time was spend by local MLAs trying to defend Daisy Hill in Newry (H/T to tinman for link). That is most likely the picture of things to come with each locality fighting to save its own hospital with shroud waving politicians and crowds claiming that “People will die” if their local hospital is closed and that their road links / traffic congestion make them a special case.
The report attempts to answer these issues with the patient observation:

The Rural Trauma Outcome Study in
Scotland (84) showed that longer prehospital
travel times did not increase
mortality or length of stay.

Such reports are unlikely, however, to assuage the shroud waving and no doubt some pseudo reason will be presented showing that in the parallel universe of Northern Ireland distances are much greater than those in the geographically vastly larger area of rural Scotland.

I observed previously that Comtpon might bottle the review: he and his group clearly have not; though they have fought shy of stating which acute hospitals should be closed which is much the most controversial issue. To be fair the issue of which hospitals should be downgraded is a political one which probably requires a decision at ministerial level. The problem is that although it requires a political decision it is still fundamentally a health care issue. Furthermore the review proposes a time scale of up to five years to implement the changes. This again is probably fair at one level (changes cannot be implemented instantly) but it does mean that we will have more delay before we can begin to try to catch up with the rest of the UK in terms of health care provision. Furthermore it potentially allows more time for campaigns and fighting to try to prevent the changes happening. It also means that Poots will have to hold his nerve for longer and if Robinson does replace Poots with Jim Wells there is a danger that some of the changes will be reversed / watered down. As I observed previously there was a proposal to have six acute hospitals as long ago as 1966.

Edwin Poots has demonstrated that he is probably made of stern enough stuff to push the changes through: today he has made it pretty clear that he is going to reintroduce prescription charges and one of his first actions was to permit the reduction of A+E hours in Lagan Valley in his own constituency. Considering the enormity of the challenges facing the NI NHS and the fact that Edwin Poots seems thus far willing and able to make the necessary changes it might be wise for Peter Robinson to keep Poots where he is for the duration of this Stormont term and make a clear announcement to that effect. Given time and stability Godot might well deliver.

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  • Cynic2

    Seems fair – 2 Catholic Hospitals, 2 Prod ones and one in between

  • Drumlins Rock

    If Pootsy pushes through the down grade of the Lagan Valley fair play to him for, this time, putting national before self interest, his record on RPA though shows a poor track record in this regard.

    Having essentially one Belfast Hospital makes sense, espically with the poximity of the two main sites, the fight over maternity that time was farcical, talking about distances when you could wave at each other between them.

  • Turgon

    DR,
    It will still be two: Royal / City and Ulster. Not that that is necessarily wrong.

  • hfmccloy

    So here we have it in a nut shell, the SFwant take the acute care down to the golden 6, the DUP not happy being outdone by the SF take it down to 5.

    The UUP played a political gamble that did not pay off and implement the SF agenda with gusto, but then again the Antrim Hospital was built by the UUP to get a dig as old Ian Sr over in Ballymena

    The Alliance having a few respected party members in the Hayes report stayed very tight lipped.

    SDLP who are they?? I remember something about a man called Hume.

    Now we have a health system that’s imploded over the past 10 years about to explode.

    But the best thing about this review, this blueprint can anyone say what its moving?, closing? GIVING?

    The assembly is a farce once again unelected unaccountable civil servants who get paid millions are raping, sorry reaping the golden handshakes while the public get screwed.

  • pacman

    “most health analysts have suggested that those five would be the correct ones to keep. The arguments are clearly going to be whether there should be another two and if so which ones: the most likely would probably be Erne and Causeway (in that order of likelihood of survival)”

    Which health analysts and what are their vested interests? And why should either of Erne or Causeway befavoured instead of Daisy Hill? Daisy Hill provides a service to large parts of County Louth, who pay for the privilege – I can’t imagine the Causeway laying any similar claims. And why should Belfast retain three hospitals?

    Where, for example, is an emergency patient from Kilkeel to go to? Craigavon has piss poor roads leading into it from most of it’s proposed catchment area (if Daisy Hill is downgraded) and the only decent road into it comes from the direction of Belfast who will have ample facilities anyway. Expect a major fight from down these parts: https://www.facebook.com/pages/Dont-let-Daisy-Hill-be-run-down-in-favour-of-Craigavon-Area/218323971539683.

    BTW, your link to the health Committe minutes is not working as it hasn’t been working since the actual meeting itself. I’m interested to know just how much the one local MLA on the committee actually protested.

  • With health costs spiraling, here too, a more efficient way of delivering services has to be found. This proposal makes good sense.

  • Cynic2

    “And why should Belfast retain three hospitals?”

    Cause most of us live there and its two hospitals – the Royal, City and Mater operate as one. And in Newry you are only 25 mins by ambulance from Craigavon.

    The issue is really one of volume. The higher the throughput the less likely you are to die in a given acute hospital because tne staff are fully experienced and skilled So for Newry its a choice of keeping a Chintzy lttle local hospital and dying there or going to Craigavon and living

    I admit that decision is a close call

  • Cynic2

    By the way, personally I would take it down to three. Belfast, Craigavon and Derry. We only have a popiulation of 1.6 million and that would be optimal – but it will never happen politically

  • Cynic2,

    That makes good sense too; east, west and the middle. As you say, it won’t happen anytime soon.

  • hfmccloy

    Joe – this review is going to cost millions to implement, its already costing £40 million to shut the Mid Ulster, and services have not improved at network hospitals, mainly antrim. They have got worse in A&E, child protection, elderly care, daycase, inpatient and out patient.

    all it does is build upon the mistakes of the past, hospitals are not in the right place everyone from health managers to health ministers have said that.

    until that basic flaw is fixed the review is worthless

  • hfmccloy

    Cynic – i sat in meetings where NI was compared to Birmingham and thats why we should have less hospitals.

    Lets see if the Birmingham model works with the tarmacked horse and cart roads we have over here, having the hospitals where you say leaves rural NI unsafe for children with meningitis, stroke vicitms, heart attacks, asthma attacks. A ambulance cannot fill the gap let by life saving services

  • tinman

    pacman: There’s a strange one. The Health Committee minutes were there in all their Hansard glory, then the assembly got a new-look website and it’s all gone. But if you Google the link you’ll get the cached version.

    On acute hospital provision, today’s ministerial Q&A includes the following on Causeway Hospital, in response to a question from Mervyn Storey:

    Again, we go back to safety, sustainability and resilience. Decisions in the Member’s constituency will be taken by the Northern Health and Social Care Trust, which currently operates a two-site facility. It may desire to continue to do that. If so, it must ensure that having a two-site facility is safe, sustainable and resilient. If the trust decides to move to a model of one hospital for its area, ensuring that people get to that hospital must be done in a way that is safe, sustainable and resilient. If lives are threatened by the closure of a hospital, that will also be a challenge for the trust.

    So the really hard decisions fall back in the Trusts’ lap. So much for political leadership.

  • pacman

    Cynic,

    A number of questions:

    Have you ever driven from Newry to Craigavon on the shortest possible route? Even with sirens blaring and traffic control in place, 25 minutes is a no-go. More like 35-40. Besides, I asked about travelling from Kilkeel (with an eye to Jim Wells MLA). God help anyone who needs emergency care during July also given Portadown’s penchance for blocking roads regularly during the period.

    Also, knowing an awful lot of people who work (and have worked) in both hospitals, they are all of the opinion that Craigavon, whilst favoured by the Dept of Health, is second rate compared to Daisy Hill on multiple levels (hygiene, patient care etc). All this despite the Trust endlessly favouring it in terms of resources.

    So IMHO, my choice would be to retain the acute status in my local hospital and live than die in a chintzy little local hospital in north Armagh whose sole qualification seems to be that previous maldaministrations at Stormont built a town there to as a monument to their own xenophobia to the other lot

    Tinman,

    Since the meeting occured, I have tried to access the minutes both on the old site and the new with no success. If I was a conspiracy theorist, I would surmise that maybe that was intentional?

  • tinman

    pacman: Try this.

  • pacman

    Tinman,

    Thanks – I did as you suggested above and drew a blank also.

    Much appreciated.

  • Boglover

    Without reading the Compton report, I am content to accept the comments above that it is a comprehensive review. What surprises me is that there seems little mention of the new Erne hospital in the comments and a word search of the report also finds no mention of either Erne or Enniskillen hospital.

    As a £276m project due to open in summer 2012, the new Erne would seem to be a strong contender to remain open, not least because I understand the funding to be a PFI project, so would doubtless cost more to close than run! More details at
    http://www.belfasttelegraph.co.uk/news/health/276m-enniskillen-hospital-with-all-the-mod-cons-16081359.html

  • One of the memorable parts of Poots speech in the Assembly yesterday morning was the statistic that you’re four times more likely to have a good outcome by travelling to an appropriate hospital than just travelling to the nearest hospital.

    Other than giving MLAs next to no time [35 minutes] to read the document before giving them half an hour to discuss it in the Assembly, the Compton report has so far been incredibly well handled, and well nuanced.

    Let’s hope the mainstream media gets past headlines about acute hospitals and can get the public engaged with the other ideas and principles it contains.