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by Steve Williams
5 July 2012

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Euro-style bailouts

How can emerging CCGs make decisions to help to ensure the financial viability of local hospitals, asks Steve Williams, member of the Practice Management Network

Surely the news story was about the imminent crisis in Cyprus or a further twist on the Greek bailout plans?

To see my local hospital flash across my television screen made me turn back and engage with the narrative in more detail. This was the breaking news that a hospital trust was under consideration by the government to be put into special measures.

This was the mainstream media reporting on a story that would only be officially reported to local GPs 24 hours later.

Within 24 hours, further stories were breaking about the potential financial time bomb that is facing our NHS. To many it comes as no surprise. Locally, financial pressures are probably well-documented, but what we have here is a complete institution, the NHS, that is being exposed as straining at all the seams and in danger of a Euro-style collapse.

The real issue here is that this has not happened overnight and there have been a series of bailout agreements that have delayed the inevitable facts being brought to light. It replicates the Greek economy, supported by the Goldman Sachs-style of creative accounting.

Of course it is not financially viable to support commissioning decisions that seek to transfer services into the community without the reality that such services need to be decommissioned elsewhere. This means that hospitals will potentially lose vital income streams.

However this is not sustainable. Will emerging CCG’s be able to make the necessary decisions that will have a direct impact on the viability of their local hospital?

Patients want services that are more convenient and closer to home. Patients want quicker access and continuity of care. However, if you advised patients that this will come at the cost of the local hospital, then attitudes change. This is the paradox. How do you develop new services, but at the same time support your local hospital?

There has never been, and there will not likely ever be, sufficient resources within the NHS to pay for every treatment and as a result there has to be an open dialogue about how money is invested for patients in the local health economy. 

It will be a few weeks before final decisions are made, but in the meantime staff must carry on providing a quality service to patients, who do not wish to be encumbered with the reasons the hospital is going broke. They simply want realisation of the expectations that have been promised to them.

As we travel along the journey to authorisation, such emerging new stories seem to shroud the future viability of the very organisations that are being created to manage healthcare in the future.

History shows us that to merge three problems into one creates respite for the short term, but without radical intervention it will lead inevitably to one major problem. There will be redundancies, there will be less innovation, there will be fewer services commissioned into the community.

However, the NHS will survive, the NHS will change and the NHS will adapt. It has done since its conception and will continue to do so.

For me it is a stark reminder of the fragility of both commissioning and service provision. Without transparency and collaboration, some organisations will be subsumed and that will be like taking the breath out of the NHS.

We cannot individually alter what has happened, but we can take a closer look at what we do in our practices to make sure that we are prepared for all eventualities. Primary care is our business and we do it well.