Sunday, November 12, 2006

Deep sense of mistrust over NHS cuts

By Adam Brimelow

BBC News, Health correspondent

Many people have protested against cuts

Thousands of people have taken to take to the streets of Leeds to protest over NHS cuts.

Demonstrations like this have drawn enormous support at events across England, prompted by concerns over job losses and possible cuts in services.

Many politicians and activists are scornful of the public consultations over these changes.

Just why is there such deep public mistrust?

Last month thousands of demonstrators packed the centre of Guildford. There have been similar protests in Hayward's Heath and Worthing.

There is another coming up in Epsom - all about saving local hospitals.

Rumours are rife about cuts in services. There is going to be a consultation, but protestors were wary of a stitch-up.

"I'm hoping this rally will do something," said one, "but I don't think that it will have much effect because I think it may be a fait accompli."

Another said: "I don't trust them. I think it's all done and dusted. I think it's all about money."

Big deficit

Surrey has five major hospitals. It is easy to see why campaigners fear the worst.

The local NHS region is heading for a deficit of more than £90million. Yet services have to be financially sustainable.

Candy Morris, chief executive of the South East Coast Regional Health Authority, said it was vital that these concerns are not ignored.

"I think it's fantastic that local people care so much about the health service. I'm not surprised.

"We all care about our NHS. And I think what's really important is that we have this process of building up trust so that at least people will feel that they're listened to."

The process is called "co-design".

At a hotel in Guildford last week about 30 people, including health managers, clinicians and activists, met to exchange ideas and information, ahead of the formal consultation.

It is one of a series of discussion seminars devised by Bob Sang, professor of patient and public involvement at London's South Bank University.

Natural justice

He said: "It is quite clear to me that unless we follow clear principles of natural justice that there is a blank sheet of paper to work with, to start off with, then they won't trust the process.

"However, that also applies to the campaigners. They must also go into this with a spirit that there shall be no preferred options."

Local activists spelt out their fears.

And health managers put their case for changing services, bringing more care out of hospital into community settings.

They say this means adapting to the needs of an ageing population, treating more patients with chronic disease, exploiting medical advances and coping with cuts in doctors working hours.

Kay Mackay, from Surrey Primary Care Trust, said the changes should deliver improvements.

She said: "Hospital buildings are, if you like the front face of the NHS.

"And people get very frightened if they think that something might happen to their hospital.

"I think where we haven't done well at getting our messages out yet is that this is about doing things very differently.

"It is about developing services really close to home."

Prepared to listen

Betty Ames, a long-time local campaigner with Age Concern, is satisfied that at long last, health officials are prepared to listen, and adapt their plans to meet public concerns.

"I think they're trying. I don't think it's just a softening-up exercise but the proof will be in the eating".

But the local Conservative MP, Anne Milton, a former NHS district nurse, remains deeply sceptical.

"This pre-consultation I feel is a way of softening up the public.

"Sucking us in, if you like, so that we see it in the terms that they'd like us to see it."

She said independent of the consultation, the key decisions are being made by local and regional health officials, and ultimately, the secretary of state.

Flawed process

A colleague of Anne Milton on the health select committee, the independent MP Richard Taylor, said the government set up the machinery to take the politics out of these consultations - with an independent reconfiguration panel to help with tough decisions - but then neglected to use it.

He said: "Consultation has been a mockery and is thought of as a mockery."

He believes that concerns over closures, coupled with what he sees as the privatisation of the NHS, may lead many more clinicians to follow his example, by standing for parliament.

"People's only ultimate weapon against authority is the ballot box. And it is a very powerful weapon."