Wednesday, October 25, 2006

Local Healthcare

A few weeks ago, I was listening to a representative of the British Medical Association on the radio. He was talking about health care provision and made the point that people wanted the best quality service they could get, but also wanted it delivered on their doorstep. He went on to say that the two things are impossible.

Everybody wants a hospital close to them, and there will be services that a local hospital can provide. It’s not possible though for every hospital to have every kind of machine though. Take CT scanners for example. These are expensive pieces of kit, and worth having if they can be used by many people in one day. This means that they have to be concentrated in larger hospitals. It would make no sense for every hospital to have one, only for them to be used perhaps once a day. That wouldn’t be a good way to spread resources.

Less obvious however, is the question of availability of medical staff. A friend of mine is a consultant in Cardiff. He is one of the best in his field. I asked him if he would ever consider moving further west and his answer was an unequivocal “no”. He likes being in a teaching hospital and values the fact that he has colleagues around him that he can talk to and share experience with. No amount of money would shift him from where he is, showing that throwing money at a problem does not necessarily solve it.

There is also the question of whether it’s safe to provide certain services locally. Let me give you an example. There are some illnesses that are so rare that if district general hospitals had to deal with then a doctor might only see one case every ten years. There’s no way that a doctor can build up expertise in this illness if that’s the case. If you refer every case to one centre like Great Ormond Street, or to a small number of large centres then a doctor might see ten or twelve cases a year, so getting the expertise to deal with the illness.

We have some experience in our family with leukaemia and with the treatment available at the Heath Hospital. It’s a centre of expertise, and they get many cases a year and have learned what works and what doesn’t when it comes to treatment. There are a number of expert doctors there who have built up expertise as a team. If you spread them out across Wales you’d make the treatment worse and more people would die of the illness. It’s like taking at international rugby team and splitting it up so the players have to play in fifteen different teams. They will never be as effective.

Local does not always mean good nor indeed is it actually safe to provide some services locally. We all want good local health services, but it’s worth remembering that if we want the best, then we will sometimes need to travel.

(Article first published in the Bridgend & Valleys Recorder)


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