Education And Debate

Management for Doctors: Managing change

BMJ 1995; 310 doi: (Published 04 March 1995) Cite this as: BMJ 1995;310:590
  1. Peter C Barnes, consultant physiciana
  1. a Hope Hospital, Salford M6 8HD

    Case study: rationalisation of hospital services

    Henford General Hospitals Trust comprises a large teaching hospital, Henford General, on the periphery of the former district and a small hospital, St Judes, in a deprived inner city area. St Judes has served the local population well for over 100 years and has gained an excellent reputation.

    Considerable opposition was mounted, unsuccessfully, to the closure of its accident and emergency department serveral years ago, to centralise the services on a single site at the main hospital. It has been understood for some time that a substantial development at Henford General would, at some stage, lead to the transfer of all services from St Judes and its subsequent closure. As a result, planning blight has afflicted St Judes and staff morale has plummeted.

    Henford General Hospitals Trust has recently undergone major management reorganisation, leading to the introduction of clinical directorates, which have now been in existence for two years. Some very clear improvements in service have resulted from this development and the organisation as a whole has adjusted well to the cultural change. Nevertheless, the clinical directors still feel a conflict of loyalties between the needs of individual patients and the needs of the organisation as a whole, particularly when considering the difficult financial circumstances of the trust. Many are disappointed that their successes with efficiency savings have not led to direct benefit to their own services. Escalating costs, continued cost improvement programmes, uncertainty about purchaser intentions, and potential instability with regard to local fundholding general practitioners have all become part of the daily routine of the management of the trust which is under considerable pressure to balance its books. The regional health authority's plan for a shift of resources within the region using a weighted capitation formula shows that Henford District will be a relative loser and as a …

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