Old BHCH is Dead. Long live the new BHCH!!??
Whilst the debate was ostensibly about finance issues, at Health Scrutiny last night, the big news was that the last nail of the coffin in the original Better Health Care Closer to Home (BHCH) project was actually being hammered in.
With no new Critical Care Hospital (CCH) being built in the next 5 to 10 years at the very least, there was little evidence last night of a chain of Local Care Hospitals (LCH) being built either.
Instead, as the "turnaround" paper from the PCT showed, the new BHCH strategy will be "revenue led" rather than "capital led". In other words instead of all new grandiose buildings, the PCT will use its commissioning role to shift more people out of acute settings into the community, with PCT nurses doing a "meet and greet" (and hopefully "Treat" as Sally Brealey observed) at St Helier Hospital to people who turn up at A&E and more community matrons.
Where capital is spent it is likely to be on smaller facilities as we have seen at Middleton Circle, Robin Hood Lane and at Shotfield. Over the next few years we will therefore see in Sutton the emergence of a local health system based round a Major Acute Unit (not a CCH) at St Helier with a modernised Local Care Network.
All of this may be much less controversial than parts of the original BHCH proposals and much more evolutionary than the massive 5 year top-down 1 CCH, 10 LCH project, which when you now think about it, was really a nightmare from a risk management point of view, as so many things could have derailed it and did!!
It should also be noted that with the establishment of the Surrey PCT to replace EEMS and the decision by Surrey Health Scrutiny not to object to Epsom's downgrade, we are seeing a decoupling of London and Surrey health strategies which clearly are moving apart, with the only thing connecting them being that Epsom and St Helier Trust will happen to be a provider of some services in both areas. However the need for an all encompassing Strategy from Dorking to Wimbledon is now clearly dead. I suspect this change will strengthen the role of local authorities in developing community health services.
The question has to be asked, why didn't the PCT try this "revenue-led" approach before and I suspect a lot of this is to do with deep seated cultural issues amongst GP's and consultants.
Clearly there are issues with specific aspects of the PCT's "turnaround" plans that should cause concern and over coming weeks I will look into them in more detail.
With no new Critical Care Hospital (CCH) being built in the next 5 to 10 years at the very least, there was little evidence last night of a chain of Local Care Hospitals (LCH) being built either.
Instead, as the "turnaround" paper from the PCT showed, the new BHCH strategy will be "revenue led" rather than "capital led". In other words instead of all new grandiose buildings, the PCT will use its commissioning role to shift more people out of acute settings into the community, with PCT nurses doing a "meet and greet" (and hopefully "Treat" as Sally Brealey observed) at St Helier Hospital to people who turn up at A&E and more community matrons.
Where capital is spent it is likely to be on smaller facilities as we have seen at Middleton Circle, Robin Hood Lane and at Shotfield. Over the next few years we will therefore see in Sutton the emergence of a local health system based round a Major Acute Unit (not a CCH) at St Helier with a modernised Local Care Network.
All of this may be much less controversial than parts of the original BHCH proposals and much more evolutionary than the massive 5 year top-down 1 CCH, 10 LCH project, which when you now think about it, was really a nightmare from a risk management point of view, as so many things could have derailed it and did!!
It should also be noted that with the establishment of the Surrey PCT to replace EEMS and the decision by Surrey Health Scrutiny not to object to Epsom's downgrade, we are seeing a decoupling of London and Surrey health strategies which clearly are moving apart, with the only thing connecting them being that Epsom and St Helier Trust will happen to be a provider of some services in both areas. However the need for an all encompassing Strategy from Dorking to Wimbledon is now clearly dead. I suspect this change will strengthen the role of local authorities in developing community health services.
The question has to be asked, why didn't the PCT try this "revenue-led" approach before and I suspect a lot of this is to do with deep seated cultural issues amongst GP's and consultants.
Clearly there are issues with specific aspects of the PCT's "turnaround" plans that should cause concern and over coming weeks I will look into them in more detail.
posted by Charlie Mansell at 12:01 pm
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