So Patricia Hewitt thinks that patients will vote with their feet and refuse to be treated at a poorly performing hospital (HJS, 26/110/06, p6) which she obvoiusly see as a good thing.

She is clearly not of this world.

Vaste rural swathes of the county do not have the luxury of competing local hospitals to shop around between. They are not like London, Manchester, Birmingham…or Leicester [1].

My little hospital is in the middle of nowhere.
It’s 30 miles to the nearest alternative hospitals. 30 miles of A-roads heaving with tractors. 30 miles of B-roads and dirt tracks for some people. Generally public transport is dire. Some villages do not even have a daily bus service to these alternative locations, they have a weekly one.
The trains are often unreliable. We are at the end of the line (literally), if a train is running late the train terminates early and it turned round to avoid any fines for late running throughout the day. The passengers are turfed out onto a bus to complete the journey [2].

In some cases our patients have already travelled 30 miles to get to us and would have to continue for another 30 to one of these alternative sites.

When you are ill, quite naturally, you feel insecure. You want visitors. You want your friends and relatives to talk to. You don’t want to be a two hour bus journey away, at the end of a phone costing 30p a minute, and which costs your nearest and dearest an arm and a leg to call.

The result of this nightmare scenario is ultimately that of a two tier network of hospitals.
The bright shiney income generating hospitals in cites and hospitals attended by the affluent and those fit, able and willing to travel.
And the other sort. The rural hospital for those too poor to travel. Those too ill to travel backwards and forwards possibly two or three times a week. Those who want to be near their relatives not face death miles from anyone they know or care for. Hospitals quietly spriralling into decline as their income is gradually sucked away.

At the moment all the talk is of community, local accountability, supporting the needs of the people. If a community needs a hospital then it needs a hospital. It should be a strategic decision. If it’s failing. Support it. Facilitate its development. What point is there in saying “you made your bed, now lie in it”? Is that supporting the community?

Patricia’s vision: Dying alone, among strangers.

Great!

[1] Besides aren’t nearby hospitals with duplication of services considered wasteful? See the Watford General/Hemel Hempstead battle.

[2] A few months ago there was a protest when passengers refused to get off – eventually the train did go to its supposed destination.

The excellent Dr Crippin has been invited to write on webcameron in the guest blog.

Given the chance, this is what I would like to say

“Dear David
Just like many did for JFK’s death I can remember where I was when Thatcher resigned. The whole bowling alley cheered, and I cheered with them.
I watched with disbelief as John Major crept in 1992 and, on a portable TV in casualty, with unconcealed joy as the results came through in1997.
By this time I had been working in the NHS for 10 years. I had seen healthcare devestated by the internal market. I saw GP fundholding dividing patients into those who could have and those who had to wait. My wife had seen examples in a specialist paediatric intensive care unit where sick children were made to wait until a senoir manager at the referring Trust was found to authorise the expenditure. I was convinced that given five more years then NHS would have been broken up like the railways. Divided up into Trusts and each sold off to the highest bidder.
I believed the Tories were evil. Socially divisive. I felt ashamed for voting Conservative in 1983. I thought I could never trust them again with the NHS.
Then Labour came along, and it was good … and then it wasn’t.
At first the money came in. We felt valued. We weren’t competing with our neighbours. Much needed staff were appointed. Money started to flow in to develop staff.
Targets had the effect of driving waiting lists down. but they turned us into a sausage machine. Quantity of care triumphed over quality.
And then, while enjoying its “best ever year”, the NHS it turned irretrievably to shit. After concentrating for so long on high profile targets, Trusts had relaxed on finances.
The truth of Agenda for Change hit. AfC was the biggest possible disaster you could imagine. Poorly, and still incompletely implemented, inconsistancy abounds. It was far more costly than we were told (to the tune more than two hundred million pounds), divisive and demoralising. It did not meet the prime objective of equal pay for equal work. Far from ecouraging flexibility of working it has acted as a barrier to role development.
Overnight the emphasis shifted. Breaking even within three months became the prime objective. Panic measures took over. Much needed staff were longer needed. Funding for education dried up. Morale plummetted.
And here we are.
We are sick of change. We are sick of targets. We are sick of playing catch-up. We are sick of the dumbing down of the professions.

You tell us “We will serve and support the National Health Service. We will never jeopardise the NHS by cutting its funding.” and that you “believe the creation of the NHS is one of the greatest achievements of the 20th century.” You say change is necessary but that it “must come from the bottom up; driven by the wishes and needs of NHS professionals”.

Have you really turned your back on the old guard as thoroughly as New Labour did with Old Labour? Are you just saying what we want to hear? Will the mask slip once if you come to power and we all return to the rampent xenophobia, slash and burn, privatise everything, greed is good, poverty is your own fault Tories we learnt to avoid in the 80s? Or is it genuinely a new form of Conservative party? The spectre of Tebbit still looms in the background and I still live in fear of ‘The Mummy returns’

I don’t trust you yet, but at least I am listening now.”