Chase Farm is again in the headlines, with local campaigners fighting to keep open its A&E services. This may not seem like news – and it shouldn’t. The concept of Chase Farm losing blue light A&E services – on clinical grounds – was first floated 17 years ago. Yet since then, the service has continued. Why? And what does this tell us about some of the challenges that the health reforms might encounter?
Health services in Barnet and Enfield have caused many a political storm. The future of Edgware Hospital nearly brought down the Major government in 1996 when the then local Conservative MPs, Sir John Gorst and Hugh Dykes, threatened to withdraw their support unless services at the hospitals were safeguarded (they weren’t and Gorst and Dykes were swept away in the landslide of 1997). Barnet and Chase Farm was one of the first trusts to be ‘franchised’ in the Milburn era, having received a zero star performance rating. Later, Chase Farm gained a dubious honour when John Reid credited the hospital with helping him discover MRSA as a political issue. Today, the hospital continues to teeter on the brink of financial viability.
That Barnet and Chase Farm’s problems have not been addressed is not for the want of trying, and nor is it the Trust’s fault. It is a victim of the simple fact that there are too many hospitals in London. As a medium-sized district general hospital saddled with both antiquated building stock (at Chase Farm) and a costly PFI contract (at Barnet), times have been tough. Combine this with the fact that numerous world class hospitals are only a tube ride away, and it is clear why this hospital is a perennial on the critical list.
However the trust has proved to be remarkably hardy. Located across two outer-London boroughs and serving many marginal seats, its political relevance is arguably greater than its health impact. And herein lies the problem. In the new world, it is easy to see how Barnet and Chase Farm could fail, or at least be radically reshaped (and slimmed down) to enable it to compete successfully for patients.
Yet the question is this: will politicians ever allow this to happen? Successive reconfigurations have been proposed and then withdrawn on the instructions of both Conservative and Labour governments, as the reconfiguration and political timetables came uncomfortably close to aligning. The logical (and only) conclusion of competition is that some providers will fail. But will politicians be able to withstand local political pressures and allow this to happen?
The NHS reforms do make it harder for national politicians to intervene, but where there is a will (or a political imperative to survive), there will be a way. Equity and Excellence: Liberating the NHS reserves plenty of powers for the Secretary of State and it doesn’t take a great deal of imagination to see how these could be deployed to mitigate the political consequences of the market. In any case, the reforms increase the scope for local political involvement and, if some campaigners get their way, this will increase still more. It is easy to see how political decision-makers who are closer to a situation will be even more wedded to existing services.
So, as local democratic involvement in the commissioning of health services grows, the political impetus to defend local services (as opposed to services for local people) will grow stronger. This could be a powerful – and not necessarily helpful – counterweight to the clinical and competitive impetus for change. The local council at Chase Farm has already become involved in discussions on its future and, as Nick Timmins has pointed out, its contribution so far hardly offers a compelling testimonial for why local councillors should have a bigger role to play in commissioning healthcare.
There are of course many Barnet and Chase Farms, particularly across London, and the ‘liberation’ experience by commissioners and indeed providers will be far from total. The extent to which national and local politicians will be willing to take tough decisions will go a long way to determining the practical impact of the reforms.