Enfield borough is saddled with a poor inheritance as regards medical facilities. The population has grown steadily over the years, and aged, but health service provision within the Borough has not kept pace. It is a sad fact that the state of health of individuals across the Borough varies widely, such that life expectancies differ markedly between the east and west sides of the Borough. FERAA is actively campaigning for remedies to this unacceptable situation.
The reasons are complex but contributory factors include the chronic shortage of GPs, particularly in the east, an issue well known to Enfield Council and the health authorities. But GPs are individual contractors to the NHS and cannot be dispatched to just any locality; arrangements have to be made that meet these realities.
The allocation of health funds to the Borough has also been a burden to the Borough – the so-called capitation deficit. Realignments within the NHS, now underway nationally, could provide relief to the Borough on both issues. FERAA sees a reallocation of resources as fundamental to improvements in the Borough.
The hospital dilemma
Enfield borough is poorly served with hospitals. The area plan of 12 years ago envisaged a complete refurbishment of Chase Farm Hospital along with a rebuild of neighbouring Barnet General Hospital, following the formation of the joint hospital trust. Barnet was rebuilt but there were never enough resources to complete the plan, and Chase Farm now stands neglected, unable to command the volume of business to satisfy financial investment criteria, with its site being picked off for housing development.
Three years ago FERAA joined with others to campaign against any further sale of assets from the site until there was a resolution to the health service issues.
A stalemate has been achieved but there is no sign that the enhanced medical services that Enfield residents deserve are going to be installed within the Borough. Enfield has now been grouped within a new larger unit, the North Central London NHS Region, and the needs of our residents are being planned within this structure.
The provision of hospital services is changing rapidly, reflecting advances in medical practice. An extended scrutiny of the needs of the whole London area has resulted in a new approach, leading commissioning heath authorities to concentrate acute services in fewer hospital units, working these resources more intensively – for budgetary, but also professional quality reasons. Chase Farm’s acute patients are increasingly needed by Barnet and North Middlesex hospitals to make better use of their more modern capacity.
Residents have been encouraged in the past to expect treatment in their neighbourhood but this runs counter to the trend that better acute treatment is only affordable when concentrated into fewer specialist units. Patients with lesser conditions can be treated in nearby hospitals lying within reasonable travel times from their homes in Enfield, but for more difficult conditions the best outcomes are to be had when treated in more advanced units – mostly located near the centre of the Capital. FERAA understands this trend and takes the view that patient outcomes are paramount to the sick and their families; but we still seek a role for Chase Farm in our community, meeting local needs as far as possible within the broader scenario.
The new organisation proposed in the current White Paper transfers control of patient services to General Practitioners, so re-engaging them in the whole treatment process. This significant change has encouraged much controversy. FERAA has studied the proposals carefully and sees the merits in simplifying the care of patients, but also recognizes that outcomes will only be boosted in boroughs where GPs step up to the mark. The prospects for Enfield in this regard are good.
There is every reason to believe that GPs represent a formidable force of diagnostic skills, one that is not optimally tapped by the present bureaucratic structure employing 65,000 officials throughout the country in 151 Primary Care Trusts, charged with managing the commissioning of health services. In future, GPs will make these decisions with direct knowledge of the patient’s needs and prospects.
What can we expect of the NHS today?
At its inception 60 years ago the NHS was instituted as service for the sick, a fallback for the nation’s health. This meant accidents, emergencies and serious illnesses, coupled with essential services such as maternity. Every passing year treatments were developed to progress the art of the possible: many patients who formerly had little chance of relief or cure now can expect an improved quality of life. This has resulted in millions more successful courses of treatment, many of which now require much less time spent in hospital. As a result the national need for beds has actually diminished along with the need to retain many smaller hospitals.
But there has also been an explosion in non-life threatening conditions for which treatments can be offered, a category known as elective medicine. Patients and their families now expect this service in addition to basic health treatments. From cosmetic procedures to reproductive medicine, these areas have competed for funds, to the point where the NHS now consumes a very large share of the national budget - nearly 20%. At some stage the mounting cost of elective medicine had to be tackled and that is what is happening now. FERAA expects in future that elective procedures and treatments will have to be restrained further to protect resources essential to treat life threatening conditions.
NHS and resources
The NHS has always been about allocating resources to patients who would benefit most. Whatever the structure, some account has to be taken of finite resources and how best to apply them. At present the National Institute for Clinical Excellence (NICE) lays down national guidelines for treatments, but local PCT’s define permitted categories of treatment.
In future, GP commissioners (a committee of leading GPs) in each borough will make those decisions with the power to commit resources themselves, and will be in a position to explain to patients what treatment they can expect. Enfield Borough Council will represent residents to the GPs in deciding overall treatment policy, and FERAA will stay in close contact with the Council to understand and make representations as its member associations request.
What is FERAA doing?
FERAA is exercising a close watching brief on the likely effects of the NHS realignment on all medical services in the Borough on behalf of its affiliated associations. We see a strong case for intervention in the allocation (capitation) of resources from government to the Borough. The case for some intervention to strengthen GP services in the east of the Borough is a high priority. The provision of a quality day care service at Chase Farm and other satellite units in the borough is also high on the agenda. Then there is the whole topic of age-related services, which has still to be properly defined.