Interview by Bob Whitehead of Communities against the cuts David Spilsbury one of two public governors elected by members of the University Hospital Birmingham Foundation Trust.
Q. David, can you tell us about your relationship with the new Queen Elizabeth Hospital?
I am one of two public governors elected by members of the University Hospital Birmingham Foundation Trust in the parliamentary constituency of Hall Green. UHBFT is the trust running QEH and a number of smaller units. Governors are not paid and our job is to appoint the Chair and Non-Executive Directors and exercise a general scrutiny of the work of the Board of Directors in governance of the Trust.
Q. About fifteen years ago, there was a strong campaign against the proposed new PFI hospital, and instead for the upgrading of the existing Selly Oak site. With the benefit of hindsight, do you think that campaign was justified?
Yes. I was Vice-Chair of South Birmingham Community Health Council when Ursula Pearce, the Chair, began the investigation of what PFI was likely to mean in 1997 and what were the alternatives. I became Chair in 2000 and continued the process.
We surveyed all the then existing PFI schemes (notably Norfolk & Norwich and Edinburgh) and our analysis concluded that in all cases the public finance option was deliberately skewed, especially over the cost estimates for “risk,” so as to make the private option inevitable. We produced our own Alternative Option, involving upgrading of the existing hospitals and a gradual transfer (10-15 years) of all services to the Selly Oak site, especially by purchasing The Dingle from the City Council, a patch of land adjoining Selly Oak station and fronting onto the Bristol Road, giving ideal public transport access. We proposed a new A&E on that site.
We carried out a public consultation on the five options that the Health Authority had to consider and the Alternative Option was overwhelmingly the most popular. When the Health Authority carried out their own consultation, the PFI option came out top. We subsequently learned of many corrupt practices involved, including all final year medical students being presented with approval letters to sign before they could collect their degrees and other such fiddles.
Q. Given that we now have the new hospital, would you regard it as being a successful replacement, in a medical sense?
Yes. It is slightly smaller than the two hospitals it replaced, but that would have been no problem, but for two changes in use.
Firstly, the new QE is so efficient and does such a good job, that the number of “out-of-area” patients has soared. People are choosing to cross the whole of the City or pour in from the Black Country, Staffordshire and Worcestershire, passing equivalent nearby hospitals. UHB, as a tertiary specialist trust has always taken major trauma and technically difficult cases from as far away as Wales and the West Country, but there is no reason why some of our workload could not have been done locally.
Secondly, changes in primary care mean that A&E usage has gone up, with people coming for relatively minor reasons and clogging up the system, sometimes because of difficulties in getting GP appointments, but often just because they are adopting the American attitude that if it’s there, they should use it.
Q. Are mental health services being catered for adequately?
I think so. The Mental Health services nearby are not part of QEH, but there are psychiatric physicians and nurses who work on wards within the hospital, since people with mental health problems, of course, also frequently have physical health needs, which are met at QEH.
Q. Is it financially secure? Are there any problems being encountered regarding finance?
Financial security is not easy to assess. There are no obvious problems at the moment. This is one issue, though, that the Council of Governors has very much in view. The Finance Director is very well thought of and UHB is the only trust in the country which has never had an operating deficit since it was set up in 1995. The PFI payments are a matter of concern to us all.
Q. Is the hospital adequately staffed?
Yes. Recent recruitment has taken staffing over 8000 and use of agency staff is fairly low and is closely monitored. There are inevitable shortages in some specialties because of national under-provision.
Q. Do patients find the hospital location accessible?
There were teething troubles when the building opened, but most people in Birmingham and all health professionals are now familiar with the site. One big problem is private hire car (minicab) drivers, who drop people off at the wrong places. Parking is privately run and people rightly complain about the charges, especially if they are frequent users/visitors.
Another big problem is with the buses. Centro has been very co-operative, but has little or no power over private companies who refuse to divert services (like the 11 Outer Circle route) or provide late night services. It took nearly a year to get a stop actually outside the A&E, would you believe?
Q. To what degree has the private sector made inroads into the hospital?
Any inroads are undesirable. Most renal dialysis is now contracted out, but all renal and hepatic surgery (we have the largest kidney and liver transplant units in Europe) are strictly in-house. Some minor surgery and treatment is referred to local private hospitals because of waiting list pressures, but all major surgery and treatment is still in-house.
Q. There are currently denials that the walk-in centres, for example at Katie Road, are under threat. However, for the medium and long term future that might not be the case. What impact would their hypothetical loss cause for the new hospital?
The obvious outcome would be increasing pressure on the A&E, for reasons given above. Walk-in centres are either run by the Community Health Trust or are private.
Q. Do you feel we now have an adequate level of public accountability for local services since the Community Health Councils were abolished nearly ten years ago? For example, are the PPGs and HealthWatch schemes suitable replacements?
No, no, no. As a member of the national council of the Association of CHCs for England & Wales, I fought abolition from the moment it was announced in June 2000. We were told that SBCHC was such a thorn in the health establishment’s backside that we were one of the reasons Alan Milburn was so keen on abolition. The trouble is that we did the job we were supposed to do.
PPGs never did any good and were replaced by LinK after 2 years. That was no better and was abolished last year, replaced by HealthWatch. Although HW is supposed to be operating in Birmingham, I see no signs of it. Potentially, it can be half as good as the best CHCs, but only a handful of HWs, mainly in London and set up by old CHC apparatchiks, seem to be working at all.