Hospital games

Our hospital is currently consumed by politics. All our energies are spent on reorganising services and desperate attempts to establish some stability. I was appointed seven years ago to hospital A which almost immediately merged with hospital B to form trust AB. We continued working as two hospitals with two different cultures but with shared directorate structures for pathology, surgery, medicine, etc. As a result of cost improvement plans, the pathology department was centralised at hospital A which was considered to be larger and in a better state of repair than hospital B. Similar changes took place in other departments.

We need continuous evaluation of change

Power struggles were, however, occurring at a higher level than affected our immediate working lives until it became clear to even the ostriches that either hospital A or hospital B was to close. Hospital B won. Indeed it was decided to build a new hospital on site B. Staff at hospital A, including myself, wept, railed, rent our clothing, and muttered dire warnings and curses, but eventually packed our bags and moved the seven miles to hospital B although the new hospital had not been built or the funding finalised. We moved the laboratory again, but this time from a laboratory opened in 1987 to Nissen huts erected during the second world war. Our directorate structure survived, though somewhat tattered, and we began again.

Then the thunderbolt. Trust AB was to merge with trust C—a further seven miles away—and become trust ABC. A totally arranged marriage. We did not know our new partners, their philosophy, their manners, or mode of living, and yet we were to work as one to achieve the supreme goal of cost improvements leading to quality service. How could this be? How would this happen? Colleagues at hospital AB, already bruised and battered by changes only just completed, met within the safety of the inner walls, decrying the low morals of hospital C, its ignorance, its lack of care, its lack of standards. New friendships were formed between people from hospitals A and B who now said the things about hospital C that they had formerly said about each other. Similar support groups met and agonised in hospital C.

Then came 1 April: a new chief executive (my fifth in seven years) and a new joint directorate were decreed. The plotting began in earnest. Management services were completely dismantled while the new structure and appointments were put into place, leaving clinical services in complete disarray with no support. These same services, however, were expected to establish new joint working practices with unknown people in unknown circumstances. Anxiety levels rose among staff who had started work at one particular hospital, were now expected to work at another site, yet had homes, child care, etc, arranged around the original base. It was clear to us in hospital AB that our new directorate had to be led by one of our consultants to support our staff. Naturally, hospital C had no doubts that it must provide a clear lead. And so the time passes, leaving less for direct clinical care, and audit and continuing professional development are forgotten.

The above scenario is taking place in many hospitals throughout Britain as a result of political decisions taken centrally. There is no evidence that these mergers or hospital closures produce any improvement in the quality of service, nor any cost improvements. In my situation the reverse is true. Nor to my knowledge is there any systematic attempt at evaluation at a local level of these upheavals, to document, research, or collect data on the effect of changes in service configuration to allow planning in a rational, informed manner.

Consultant staff have become the stuff of Greek legend, constantly establishing a clinical service, only to have it demolished by external decision makers with instructions to re-establish in a different location, with different staff, and unknown or even unavailable support facilities. Countless hours are being wasted in meetings to reorganise services previously working well, with all the attendant bitterness, aggression, jostling for position, and fighting for the requirements necessary for work. Goals are short term, with senior management staff moving on with bonuses when these goals are achieved, leaving behind demoralised staff in chaos.

Clinical staff care about their service; it is not a board game to be picked up or discarded at whim. Nor do patients appreciate being treated like pawns. We need continuous evaluation of change to ensure that quality and cost containment are being achieved. Change is always a necessary force but must be controlled and brought about after thorough research, an explicit statement of goals, and detailed plans of how these goals will be brought about. It is time to take account of local needs. We need local heroes in local district general hospitals to stand firm and call a halt to uninformed service changes.