The Challenge at Kingston Hospital: cuts not closures

Before the election, the challenge was to stop major closures at Kingston Hospital . NHS managers were seriously contemplating the closure of the maternity unit and the Accident and Emergency department. Initially, I led the campaign without the support of other parties, but eventually everyone came together, and those closure plans have been ditched.

Now the challenge isn’t closures. It’s cuts.

Health spending constant, but NHS cuts?

The problem is this. Health spending overall is not being cut – unlike budgets for councils, defence, transport, business and so on, where there are large cuts.

However, maintaining health spending at current levels is still a huge challenge – as the demand for extra health spending tends to rise faster than inflation, because we have an ageing population and the rising costs of technology and drugs.

So, to keep the quality of healthcare the same, or better, major efficiencies will be needed.

Under the last Government, NHS officials drew up plans to achieve those efficiencies – because they knew whoever won the election, major efficiencies would be required. And so across London , their plans emerged, involving the closure of hospitals, or of major units like Casualty Departments, Maternity, Elective Surgery and so on.

Now the approach is somewhat different for Kingston .

The challenge now is to find savings from better use of technology, sharing back office functions, more services carried out in the community, hospitals sharing services like pathology and reducing the average length of patient stay in hospital.

Such savings and efficiencies won’t be easy – not least because in stark terms, it means people losing their jobs, from secretaries to nurses and from finance managers to consultants.

Cuts at Kingston

In Kingston Hospital , we have just learnt what that means. It means losing 486 jobs over the next five years.

What does that amount to? Nearly 20% of the workforce. Just under half of whom will be nurses, midwives and health visitors.

While this reduction will be staged over five years – with no plans for compulsory redundancies – no-one can deny it won’t be challenging.

Especially because local MPs like myself, as well as local GPs, unions and others, are already asking hard questions about the impact on the quality of care.

Keeping quality of care

When my wife gave birth to our son in Kingston just over three years, my overriding impression was of fantastic staff, but overstretched.

So I do know that in some areas at least, it’s not obvious that staff can be reduced without affecting the quality of care.

The question for this five year strategy is, are there no areas where staff reductions are possible, without quality reductions?

I am told that every single project for reducing staff is being accompanied by a quality of care impact assessment.

I am told that the aim is actually to seek to improve quality of care in this process.

So that consultants send their post-consultation letters off more quickly, using voice recognition software, saving staff time and speeding things up for the patient.

So that electronic prescribing is introduced, which can eliminate errors and improve patient safety, whilst saving on staff.

So that consultants are on wards more often, to assist junior doctors in making quicker and more accurate diagnoses.

A way forward?

The campaigns I fought to stop closures at Kingston Hospital confirmed my views of many things – not least, the fantastic local support for our hospital.

They also confirmed my belief in the need for major reform in our NHS.

There can be no doubt that over three terms of Labour Governments, spending on the NHS rose rapidly. And I saw real improvements locally as a result. Yet I was never convinced that the improvements were sufficient – or that improvements could only ever be achieved by extra spending.

So the Coalition Government is surely right to look to reform and great efficiency, at least for the next few years - whilst protecting health from the greater cuts being faced elsewhere.

However, we must ensure the quality of patient care is not sacrificed in all this.

Locally, we are actually well-placed to meet this difficult challenge.

We have a group of GPs ready to work together, who support our local hospital. We have hospital management ready to press ahead to achieve Foundation Trust status, which will help secure Kingston ’s long term future.

We also have major new investment coming into primary health care on the Surbiton Hospital site. And we have primary healthcare staff working in the new “Your Healthcare”, a local social enterprise leading the way in new ways of working.

The next five years will be challenging and tough – but now we have won the battle for Kingston and Surbiton hospitals, and key services like A&E and Maternity, I think we are well-placed to emerge stronger and healthier.