Hospital infrastructure 'not fit for purpose'

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Doncaster's hospital buildings are 'not fit for purpose' in the modern age, and need work done to transform them.

That is one of the views raised in the second part of our round table on healthcare in the borough, along with the need to put more resources into mental health care, and preventing illness. The third part will be printed next week.

Doncaster Royal Infirmary. PIcture: Matt McLennan

Doncaster Royal Infirmary. PIcture: Matt McLennan

Our panel was Doncaser MP Rosie Winterton; Primary Care Doncaster chief executive Laura Sherburn; Doncaster Healthwatch chief executive Andrew Goodall; Doncaster Council public health consultant Dr Victor Joseph; Doncaster Patient Participation Group members Barbara Bell and Geoffrey Johnson; Secondary care doctor member of Doncaster NHS Clinical Commissioning Group Dr Emyr Jones; Doncaster Royal Infirmary medical director Sewa Singh, and Rotherham Doncaster and South Humber Healthcare Trust care group, Jo McDonough.

The Government says it will provide an extra £20billion for health by 2023. How Should Doncaster's share be spent?

Emyr Jones: There's no simple answer. The demands on the health service are increasing. A lot the increasing demand is because of the changing demography. People are getting older and as you get older you develop more conditions and you're more dependent on health services and social services in order to maintain independence of living. But its not just that. Technology is improving all the time but getting more expensive. Surgical techniques, medical techniques, drugs, medication, all getting more expensive and more common and more available. Interventions are getting more successful so people are surviving conditions which they previously wouldn't survive like cancer, heart disease and strokes. One of the things we've met recently is the big pressure on hospital services. They are currently overstretched and under-resourced in terms of their capacity in terms of staffing and specialist availability and IT infrastructure. I'm pointing out where the problems are and the additional resource will help us address some if not all of those.

Andrew Goodall: If there's new money coming in its a real opportunity to listen to patients and people so we can co-produce changes with the people of Doncaster and I think by listening to experiences and people, new and existing services can be transformed to really meet need which will then make people use them more efficiently and effectively. The may be a chance for different diversionary or preventative services rather than just classic NHS frontline acute services but unless people are engaged in the conversations, some times they'll feel on the outside of that.

Jo McDonough: I think from my perspective, a focus on mental health has got to be something that is part of that. The things we're seeing at the moment is for men, aged 30-45, suicide is the biggest thing causing death. We've got an ageing population with significant prevalence of dementia and we also see the pressures that our young people and children are facing.these days. Some of the provision for those people is not good enough. We're not doing enough to support them in the challenges of life, not necessarily labeling them with a mental health condition. People at that age who do need care in an inpatient setting are being sent all over the country, miles away from their families to have that support and we question is that really going to help them. Some of the scandals we've seen nationally about why our young people are having to go across the country to access in patient care are things that we really need to look at. I think all of those are important for mental health, but also physical health because everyone's mental health has an impact on their physical heathcare as well . It's important we look at prevention and health and well being in primary care and much more with communities, with some of the charities and local organisation to help people live healthy lives for physical and mental health. For those that really need mental health care, we need to get that right.

Dr Victor Joseph: I think its really important that if we have this money, the resources are likely to be limited, so how can we best use our limited resources? It is about helping our population to live healthier and longer. At present, life expectancy of our is about 80 years old for a child born now. The challenge is that we have got people living 15 to 20 years in ill-health, and we need to ensure that this improves. This puts a lot of pressure on the NHS primary care and secondary care. The approach we need to take is is we need to take a partnership approach and strengthen that, and prevention should be at the centre of it.

Laura Sherburn: It should, but it always suffers because investment in prevention, weight management, reducing obesity, which is a massive problem for Doncaster, in preventing social isolation, that sort of issue, they aren't the sexy things that hit the headlines, because when you've got people waiting on trolleys for hours in A&E, or waiting times that exceed 18 weeks, those are the things that make the headlines and inevitably suck up the investment because they have to be fixed now. If we had an additional amount of money, I'l like to see a bit more strategic thinking about how we use it to make the health and social services sustainable in the future. Just pouring it down the same black hole around waiting times and immediate need is fine and necessary but it doesn't address the systemic issues that we have to address.

Barbara Bell: I think the movement forward is services in South Yorkshire working together, and there will be different hubs set up for different disciplines in each area and people will have to travel. I don't think it will be a case of trying to grab some money out of the pot of £20 billion unless over the next five or 10 years we alter our way of working completely, and that means joining together. The whole ethos has to change towards moving forward collectively rather than individually. People have got to be mindful of this and work with the system. Instead of trying to do expertise in various areas, saying 'I want Doncaster to be an expertise in such and such', and Barnsley saying the same, it's got to be a collective decision on where these expertise hubs are going to be, instead of giving small amounts of money to each hospital and protecting their own area as we've seen before. We've got to think of saving the money put out to five institutions, and putting that money into one would be saving money. That's the way forward and that's what's going to happen.

Rosie Winterton: One of the problems is the Government hasn't said how its going to pay for this. All public services have an effect on the health of the nation and if £20 billion comes from social services or education, there's a problem. Some of social services work provides care for the elderly and keeps them out of hospital. If they're cut to the bone then that's not going to work for the NHS as it will just mount up the bills in another area. There is a need for integration of services. That's something people have known for a long time. If all services are cut back, that falls apart. It can't become a bidding war, it has to be people saying what the priorities for Doncaster and where are the gaps we need to fill. In some cases it may be a case of where to we centre certain techniques. I also think there needs to be more horizon scanning on purchase of drugs and looking for ways to get some of those on the market more quickly and sometimes at a better price for those who need them.

Sewa Singh: The £20 billion overall for the NHS is welcome. If you look at the NHS, the way we deliver healthcare has altered over the last 40 or 50 years yet the infrastructure we are using was designed and built in the 50s and 60s and is not fit for purpose. and the £20 billion we currently spend does not include funding for capital. We need capital expenditure at this moment in time in order to transform services. You're right, the NHS needs to change the way we deliver. There's a lot that needs to be delivered close to home, and a small minority of patients who may have to travel for very specialist care. But actually the buildings and infrastructure that we work in needs to be altered to facilitate that and at the moment in Doncaster our infrastructure just does not support what we need going forward.

JM: I think workforce is another significant issue. even if the money comes tomorrow we're all fishing in the same drying up pool for qualified staff to work in the NHS. I think working together is a way of doing that but I think there's still something to do about how we attract staff into the NHS. We struggle to recruit doctors and consultants nationally. nursing staff are difficult to keep and retain, so it's key that we work across areas like South Yorkshire instead of competing for the same staff.

RW: We also need to take account of leaving the EU in terms of staff. It's about how you continually train people in the longer term

EJ: There's an opportunity locally with the the announcement of the University Technical College. It could help to train those who support the technicians in the hospitals. There's a chance to attract people to the UTC and healthcare.