Healthwatch: Revolution in health care provision nearer to home

There is a revolution going on in Oxfordshire. And it affects you.

It’s all about your health and how you will be looked after. And like every other kind of revolution, theories and high-flying words of good intentions are floating through the air like confetti at a wedding.

The general message is that people will be better off if they are treated nearer their homes. But will they?

Family doctors, hospitals, care homes and home carers are struggling as the government demands more and better services while cutting their cash. That is a familiar cry in the world of business but still a shock to the system in the public sector.

But the concept of care nearer home has worked in the past. Before the building of the giant district hospitals, such as the JR in Oxford, each market town had its own hospital and in Oxfordshire most of those are still there, although their role has changed.

As the revolution gets under way they will have to change again. The idea is to put more specialised services into communities, and where better than the community hospitals even if they have to be upgraded? They already provide some valuable post-surgical services and if diagnostics and treatment for minor illnesses became the norm on a more local basis many people could be spared a trip to Oxford to see a specialist or to the accident and emergency department.

However, a major problem in Oxfordshire is that the number of older people is growing and relocating them after treatment in the JR in particular is presenting difficulties, which we highlighted in our report on hospital discharge procedures, and which has still to be overcome on an ongoing basis.

Social care is provided by Oxfordshire County Council and the liaison between them and the hospitals needs to be improved to avoid beds being blocked in the major hospitals. However, the council is faced with a similar dilemma to the hospitals. They are under pressure to provide services, including care at home or in care homes, while having their budgets slashed unmercifully by the government.

The major worry is that the elderly and vulnerable being cared for at home will suffer as the council is considering cutting services to the bone.

According to a survey carried out for Healthwatch Oxfordshire by experts in rural lifestyles, a growing number of elderly people in this rural county are already experiencing loneliness, which detracts from their wellbeing. One suggestion from the authorities is to step up the action of voluntary groups. But the same survey showed that many voluntary groups are working flat out already and are having to spend more of their time fundraising as grants are being cut.

Among all this is the debate about whether GPs should be opening their surgeries seven days a week. They do not want to and claim there is no demand, although it is difficult to see this as a fact until it has been tried.

Experiments where practices are joining together could result in a more even spread of services as opposed to a five-day week service from individual practices.

At the time of writing the future of all these ideas is in the melting pot because neither the hospitals nor the county council has much idea of how much money they will get from the government to provide services – except that it is likely to be less.

Unlike most popular revolutions this one is being organised by the people at the top who run the services. Apart from county councillors, those who run the hospitals and other services are not elected directly and decisions are being taken mainly behind closed doors.

Healthwatch Oxfordshire has been pressing for public representation on the body that is making the recommendations for this new model of care and we think they should be consulting the public earlier.

p Don’t you agree? You can put your point of view on healthwatchoxforshire.co.uk where we will be reporting and questioning the changes as they happen.