Dorset NHS – inequality on the increase

Health in Dorset – an overview

Surely Dorset, with its beautiful countryside, glorious coastline and clean air is one of the healthiest places to live? While there is much in Dorset’s natural environment to support our health, sadly we are experiencing an unprecedented attack on our health services.

Concentrating services

The principle of concentrating services may work well in urban areas, with dense populations and good transport, and where the maximum time to centralised care is 30 minutes. However, it is another matter when, despite the lack of any supporting research evidence base for rural areas, the same principle is used to reduce access to emergency and routine care for a largely rural and dispersed population, worsening health inequalities. In addition, Dorset has areas of chronic traffic congestion, winding country lanes, no motorways, poor transport and stretched Ambulance services.

Dorset’s health crisis

Since 2010, the NHS in England has been ‘squeezed like it’s never been squeezed before’. This relates to the annual uplift on the national NHS budget, traditionally 4% per annum, being reduced to 1.2% on average, year after year. At the same time, the ending of Nurse training bursaries, and the tripling of tuition fees to £9,000 per year, deterred people coming into the NHS, while the 8 year 1% pay cap, contract disputes such as the Junior Dr’s, and the stresses caused by lack of staff and funding, caused staff to leave the NHS.

Dorset was no exception: Dorset Clinical Commissioning Group projected an annual budget revenue deficit of £158 million unless services were cut. This has resulted in the plans to downgrade Poole Hospital A&E and close Poole Maternity, leaving only one A&E, and only one Maternity department, to serve the conurbation catchment area and West Hampshire. Poole Children’s unit will also be relocated at Bournemouth Hospital, as will oncology beds.

Bournemouth Hospital is in the far east of the County, on the border with Hampshire, on the other side of the chronically traffic congested conurbation. Dorset is a dispersed, largely rural County, with no motorways and poor public transport. The loss of emergency adult and children’s medical and trauma care, and the loss of specialist maternity care from Poole, mean lengthy journeys to hospital in emergency, beyond safe guideline times, for whole tranches of the Dorset population. Distance is also likely to affect visitor’s ability to support loved ones in hospital and the take up of non emergency care.

Furthermore, Dorset Clinical Commissioning Group’s cost-cutting plans involve the closure or loss of all beds in five of Dorset’s 13 Community Hospitals. Some beds have also been cut in the remaining eight community hospitals – Bridport Community Hospital has lost 20 of its 44 beds, for example. The plans also include the closure of 245 acute hospital beds: although beds are projected to increase at Bournemouth Hospital, 2/3 of Poole’s beds and a tranche of Dorset County Hospital’s beds are scheduled to close, with a net loss of 245 acute beds.

The Corona virus pandemic

Dorset was relatively lucky during the first wave in terms of the number of fatalities. The Office for National Statistics reported 329 Dorset C19 deaths by the end of May 2020. However, national statistics during the first waves showed that one in three of those who are critically ill, dies, suggesting the number of patients who became critically unwell here was close to a thousand.

When the approximately one thousand patients who needed critical care during the first wave is balanced against the just 30 critical care beds available for the whole County, the picture becomes alarming.

The coronavirus pandemic has revealed that there is a severe lack of beds in the system before any further cuts are made. The needs of C19 patients for hospital beds during the first wave of the pandemic were managed by stopping all planned operations, and clearing beds, by summarily discharging patients into Care Homes, with tragic consequences.

Jeremy Hunt, the Chair of the Health Select Committee, reported that in the first wave, around 1/4 of C19 infections were contracted in hospital. This reinforces the need to retain A&E and Maternity departments at Poole and Bournemouth Hospitals. This, combined with adequate testing, would support Dorset infection control by enabling the separation of C19+ patients, and patients without C19.