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8 November 1999

Designed to see to all our needs

New Statesman Scotland - Colin Douglason the first fruits of plans to meld the health servi

By Colin Douglas

Here in the Greater Auchendreich Health Board area we pride ourselves, as skilled and committed health professionals, in providing for our citizens the best of modern healthcare. Ever since the publication of the landmark white paper Designed to Care in 1997, we have worked together in the new spirit of partnership, leaving behind us the divisive ethos of the old regime that for years fragmented our health service, pitting hospital against hospital, doctor against doctor, trust spokesman against trust spokesman and mission statement against mission statement.

Seamless care is one of the most important goals of Scotland’s exciting new health service reforms. The old ways, whereby patients referred to hospital embarked on a nerve-wracking game of snakes and ladders (throw a six for a place on the waiting list for outpatients . . . Well done! But turn up 18 months later without your X-ray . . . Sorry, we’ll try to fit you in if there’s a cancellation some time in the next year or so . . .), are now gone for ever; particularly here in Auchendreich, where all the elements of our once controversial reconfiguration plan are now gradually melding into a single smooth-running machine, finely tuned to provide the people of Auchendreich with the healthcare they need, as soon as they need it and as near as possible to the patient’s home.

But this takes time, and while much progress has been made we must also recognise that there is still a good deal to be done. The sudden resignation of all six orthopaedic surgeons in response to a discussion paper on managed clinical networks, though widely reported in the local press as a setback, should now be seen in its true perspective as creating an opportunity for structural change.

As we keep reminding ourselves, the worst thing to do at a time of rapid change in the NHS is to get immersed in matters of detail. The real healthcare news here in Auchendreich is about the progress being made in forging vibrant new alliances spanning all specialties and disciplines, linking community and hospital service provision, bridge-building with social work and tearing down the traditional barriers such as those between chiropody and psychiatry, to create a seamless web of care, while at the same time implementing a resource reallocation exercise between hospital and community services, which also happens to mesh effortlessly with the most radical bed-closure programme undertaken in our area since 1948.

Six months into that challenging agenda, it is time to take stock. The health board’s original outline document envisaged a simple structure of two “Local Health Care Co-operatives”. Over a period of particularly productive negotiation, that number fluctuated from one to seven as our GPs variously pursued ancient feuds and sought new alliances, before settling finally for three, partly to teach the board an important early lesson, but mainly to reflect three very different approaches to the interpretation of the LHCC concept within the flexibility wisely allowed by the white paper.

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North of the river in Dreichmuir, a windswept drift of largely employment-free housing estates, formerly a new town, the LHCC is led by an outspoken job-sharing duo of women generally referred to out of earshot as the militant vegetarian tendency. Their style is refreshingly direct. They simply report the views of mass worker-and-patient meetings that debate each issue in detail, the chairmanship rotating hourly between the two groups, and take back the trust’s views for further debate in the same forum: a routine that, they say, ensures real sign-up for a radical multi-agency bottom-up approach to health improvement.

In the more genteel environment of Old Auchendreich, once a stronghold of well-organised, not to say predatory, GP fund-holding, the doyen of the former fund- holders has grasped other opportunities, taking over on behalf of his LHCC a cottage hospital, several community clinics and – by virtue of the location of the old Royal Dreich Asylum – the area’s psychiatric services.

Happily, the remaining GPs have adopted a more conventional approach. A fraternity characterised by Range Rovers, tweeds, gun dogs and the local tradition of dispensing rural practice has developed a brisk, no-nonsense approach to LHCC development. That has brought them many advantages, including chairmanship of all the important committees, an achievement that has the merit of uniting the militant vegetarians and the sabre-toothed fundholders in at least one common cause.

In the hospital sector progress has been slower: Auchendreich General and the Royal Auchendreich Infirmary, a still rather haughty Victorian charitable foundation, responded to the challenges of our new unified acute trust simply by pursuing their ancient enmities by other means.

Co-operation will, we are sure, be forthcoming in due course. Though the local press snipes at it as “a really clever way of paying £700 million for a £100 million hospital”, our much-acclaimed Private Finance Initiative, which reduces the burden of acute beds by 40 per cent, has at least succeeded in uniting patient, GP and consultant opinion throughout the entire Greater Auchendreich Health Board area as never before.

Colin Douglas practises medicine and writes a column in the “British Medical Journal”

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