Rapid Responses to:

LETTERS: Stephen Black It's not just whole hospitals BMJ 2007; 335: 272-a [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Not big supermarkets

Adrian R Leahy   (14 August 2007)

Not big supermarkets 14 August 2007
Adrian R Leahy, Staff Grade Psychiatrist Guild Lodge, Preston, PR2 2JH Send response to journal: Re: Not big supermarkets	Please let us not be lulled into a state of optimism by these impressive travel times. If the discussion centred on supermarkets I would agree with the sentiment, but most members of the public would be amazed to discover on visiting their local supermarkets that one did not stock bread, another did not stock butter and yet another stocked neither of these "bread and butter" items. To return to health issues, I am afraid that not every hospital has an Accident and Emergency Unit to welcome the consumer to health services, nor an Intensive Care Bed vacant in the corner for those "special occasions". Not all have access to Obstetrics to welcome the "first-time customer" with a special care cot vacant upstairs. Not all will supply acute Surgery or Emergency Medical cover 24 hours a day and trying to get a Psychiatric bed requires there to be a psychiatric ward in the hospital. Other specialties will I hope forgive me if I avoid labouring the point by mentioning every craft and skill we as doctors know would be required to have what we would call a proper district general within a convenient travel time for the majority of the population. In business terms then, could we see the stock list available before we set off in the car please ? Otherwise we may not view what is available on arrival as being adequate and feel a little cheated on being told that, despite it being advertised as a modern supermarket, no bread is ever stocked and no "in-store baker" employed. My serious point is that I am not aware of any service standard for a general hospital ever having been agreed between the profession and the "serious decision makers". A "rational provision" would be expensive and thus unlikely to pass political approval. Your figures for travel time are thus both invalid and a dangerous line of thinking to encourage until a rational service provision has been drawn up. Your results are so attention-grabbing at first sight that they risk become quoted as "fact" by the unwary. What are under discussion however are not big supermarkets. In this case uniquely the customer has already paid up-front and trusts that the employees, his fellow citizens, will have advised somebody in authority of the foolhardiness of shutting the bakery and cancelling the delivery of butter, well in advance of the customer actually arriving to collect what he understood he was due. Competing interests: None declared