DESPITE standing down as a governor of the RD&E NHS FT in Exeter last autumn, a position which I held for several years, I have continued to show a keen interest in our health services.

It is common knowledge that NHS FTs across the country are suffering, many of them close to bankrupt with huge deficits, predicted to increase in the coming years. The current situation is clearly unsustainable. With this mind I was keen to accept a recent invitation to attend the scrutiny committee meeting at Dorset County Council at which the future of health care in the county was due to be discussed.

It is generally accepted that there has to be cross-county border cooperation, more joined up thinking and integrated services. At present there is clearly too much duplication and a need to utilise technology in a more effective way.

With a predicted overspend of £158 million by 2020, there is no doubt that we are all in trouble and the need for change, by doing things differently, is clear to both to the clinicians working in our health services and those of us who have need of their services.

During the presentation we received reports on progress so far and an outline of possible options. One of the biggest challenges facing the NHS is that of recruitment, at all levels, along with the rapid rise in population over retirement age, particularly in the South West.

The majority of available resources is spent on these older patients who have more complex multiple needs requiring low level intervention.

They are not usually in need of emergency medical care, and by rights should be kept out of hospital, but are not well enough to be able to manage on their own at home. The lack of provision to provide for their long term care within the community, closer to home, has been ongoing for some time, and can be the cause of the ‘bed blocking’ we so often hear of.

In terms of acute care one option being considered is a split between emergency and planned care, with separate sites being used for each. On the surface this seems to be a sensible option as we often hear of ‘planned’ operations being delayed or cancelled due to emergencies arising beyond the hospital’s control.

However, if there was to be a major disaster in the area presumably all available beds would be required, no matter where they were located.

Across the South West, options for shared working are being considered. Whilst this is desirable, what needs to be taken into account is the impact on patients, and those supporting them, in terms of location and travelling time where health services may be split across several sites. Whilst money is an issue, and has been for some time, what must be paramount is quality of patient care at the right time, in the right place. The NHS is a ‘service’ intended to satisfy our needs; we pay for it after all.

Regardless of the decision taken, any change is likely to be a lengthy drawn out process, discussed ad infinitum at meeting after meeting, prior to the necessary public consultation.

We are unlikely to see the necessary changes being put into place any time soon, although doing nothing is not an option.

As it stands the NHS is clearly unaffordable. Whilst it is easy to criticise, what we must not forget is that at the time the NHS was set up there was less demand for services, our lifestyles were different, many of the illnesses we now receive treatment for had not been diagnosed, and we are living longer.

We can only continue to re-jig things for so long.

Perhaps it is time for us to consider whether or not we all need to pay more to have the level of service we want, or consider the unthinkable; should we be keeping people alive at any cost? For me, it is more about the quality of life I am able to lead rather than how long I live.

Linda Piggot Vijeh

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