NHS Services (Hertfordshire)

I was not suggesting that they were community hospitals, but the descriptions are relative, and we could compare them with St. Thomas’ hospital over the river from here. I am familiar with the scenario, because I come from an area where there are two hospitals that I would describe as relatively small in NHS terms and that are separated by the sort of distance that separates some of the Hertfordshire hospitals. I am fairly familiar with the problem—I know that hospitals belong to distinct communities, I know that travel between them is rarely ideal and I know that there is strong community resistance to changes in local hospitals. I also know that when change takes place, there is an unconvincing process of local consultation that satisfies nobody and buys nobody off. There are usually two drivers for reconfiguration. A clinical driver to do with the concentration of expertise is usually cited in evidence, and there is usually a financial driver. The financial drivers on hospitals involve not only deficits but other things, such as the working time directive and the junior doctors’ contract, which put additional pressures on hospitals in all areas. None the less, people in Hertfordshire are quite justified in fearing reconfiguration, because reconfiguration and all that it evokes has a pretty poor reputation across the NHS. Looking at the SHA consultation on reconfiguration in 2003 from an external point of view, I thought that an attempt was being made—although probably not a successful one—to give everybody a little piece of the action or to satisfy everybody, if I may put it like that. Clearly that effort failed and was replaced by something much more unacceptable. In my neck of the woods, with two hospitals separated by the same sort of distance as between Watford and Hemel Hempstead, we have already lost obstetrics and paediatrics in Southport.