Private finance initiative
BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7229.250 (Published 22 January 2000) Cite this as: BMJ 2000;320:250All rapid responses
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Dr Frank McGinty's letter in the BMJ of 22nd January would give the
impression that everything is under control in Herefordshire and that
future patients' care is assured. This, however, is far from the view
that we have from the GP's perspective. He talks about more home care
within the NHS led by primary care. We, as yet, have not even been
approached about this policy and surely the co-operation of GPs is the
first thing to be needed to see if it can work.
We do not have a community hospital within the City to replace the
one that was abandoned some 10 years ago. As far as I know, it is most
unlikely that we shall ever get one. A few beds are planned in nursing
homes, but this will be an inadequate replacement.
As GPs, we have consistently found it difficult to get patients admitted
to our hospital over these last few months. What the situation will be
when the bed numbers are so much smaller with the new hospital is a cause
of worry to all of us.
The LMC has argued against the drastic reduction in in-patient
facilities which are proposed and always been told that this is all that
can be afforded. It is not a question of need, but one of cost
limitation.
Inevitably, with more ill patients in the community, more GP time
will be needed. However, as things are, it is unlikely that the MPC would
allow an increase in our numbers.
I do not want to be alarmist, but I do not think the future bodes
well.
Adrian Eyre
Secretary
Herefordshire Local Medical Committee
Competing interests: No competing interests
EDITOR--I was rather surprised that Frank McGinty felt that clinicians
in Hereford were "satisfied with the result" of the PFI plans (1). Very
few of the Hereford hospital doctors that I have talked to are confident
that the new smaller hospital will have enough beds to cope with local
demands and GPs through the LMC have consistently maintained that they
feel that the new hospital will be too small. The county already has an
efficient network of GPs and community hospitals in the market towns and
there is very little slack in the system.
Perhaps one reason why Mike Deakin maintains that hospital admission
rates have not risen in Hereford (2)is because it is such a struggle to
have a patient admitted. Indeed the hospital has recently been closed to
admissions. The experience of being told that my patient with pneumonia
and status epilepticus was number four on the waiting list for admission
gave me little confidence in the hospital's current ability to cope. In
recent weeks I have opted to manage a patient with a pulmonary embolus and a
patient with a haematemesis and a haemoglobin of 7.5 g/dl at home because of
the problems in finding beds, which I felt very unhappy about. I would
also be dubious about trusting information from a new computer system that
has not even been able to give us waiting list figures since the summer.
It seems clear that in the planning of our PFI hospital the size was
dictated by the affordability, and then the planners tied themselves in
knots working out how such a small hospital could possibly meet local
needs. Construction companies are not philanthropic bodies, they are
profit-making organisations who will extract money from the public purse
to benefit their shareholders. No amount of sophistry will make me belive
otherwise.
Jonathan Sleath
General practitioner
Kingstone, Herefordshire
(1) McGinty,F Partnership between private and NHS is not necessarily
wrong. BMJ 2000;320:250-1. (22 January.)
(2) B McCloskey, M Deakin Series did not address real planning
issues. BMJ 2000;320:251. (22 January.)
Competing interests: No competing interests
Lesser of two evils
Dear Editor - McGinty's letter regarding the Hereford PFI scheme is
potentially misleading.
Hereford's hospital clinicians were presented with the option of accepting
a new hospital on one site but with fewer beds, or continuing on three
separate sites in obsolete and decaying buildings. The clinicians
reluctantly accepted the PFI as the lesser of two evils.
We believe a hospital of 340 rather than 250 beds would best serve the
needs of the population and this view is now vindicated by the National
Beds Inquiry.
E J Barton - Chairman Hospital Medical Committee
Hereford Hospitals NHS Trust, The County Hospital, Union Walk, Hereford
HR1 2ER
McGinty F. Partnership between private and NHS is not necessarily
wrong BMJ 2000; 320: 250-251 (22 Jan)
Competing interests: No competing interests