This lack of joint local leadership has hampered efforts to focus on preventative

community care away from an acute setting and reduce pressure on primary

care providers. Time and again the local authority experts that we interviewed

suggested that one of the reasons for the lack of integration between health and

social care services is because there is too much focus on hospital provision.

There are several possible explanations for this. Firstly, hospitals are large, wellknown buildings

and as such are much more visible than community services,

which is one of reasons that, over generations, hospitals have become seen as

cultural embodiments of the NHS. Additionally in recent times we have seen

substantial increases in people going to hospitals to get healthcare provision -

both due to misunderstanding of the critical nature of A&E services and due to

actual or perceived difficulties in accessing primary care.

These absence of local leadership is especially clear when it comes to clinicallyled programmes to reform

A&E services, where local politicians of all colours

rush to the barricades to fight any change, no matter how rational, and there

is no-one at a local level who can explain why every hospital providing every

service is an inherently flawed approach. As some have argued, it would also

help if there was a bit more of a concerted attempt at a national level to make

the case for A&E reform.66

But the acute sector itself has faced criticism for being self-interested and fighting

changes that would improve outcomes for patients. For example, when recent

research studies revealed that patients were 16 per cent more likely to die if

they were admitted to hospital on a Sunday NHS England's national medical

director announced plans for hospitals to have access to x-rays, ultrasound

scans and emergency general surgeries at weekends. These plans were met

with criticism by the British Medical Association who said: "a full NHS service

24 hours a day, seven days a week, is neither desirable nor feasible".67

The NHS Five Year Forward View, published in 2014, called for greater

local democratic leadership on public health matters.68 It suggested that the

NHS would work with "ambitious local areas to define and champion a

limited number of models of joint commissioning between the NHS and local

government".69 As part of that it agreed with the Local Government Association

(LGA) proposals that local authorities should be granted enhanced powers to

allow local democratic decisions on public health policy (e.g. on alcohol, fast

food, tobacco and other physical and mental health issues) that go further than

prevailing national law.70 The shortcomings of the current arrangements are

thus well recognised but public health, while important, is only a small fraction

of the total health and care budget.

66 White, M, "Our creaking A&E

system needs restructuring, no

ifs, and - or butts" The Guardian

(13 November 2013)

67 BMA, Best for patients, fair for

doctors, sustainable to the NHS

(December 2014)

68 NHS England, Five year forward

view (October 2014)

69 NHS England, Five year forward

view (October 2014)

70 NHS England, Five year forward

view (October 2014)

Chapter 3 - What Is The Diagnosis? Or Why Are We Failing Our Elderly?

23

if the Trust got into financial difficulties but, having weighed up the risks, they

concluded that protecting healthcare services and jobs within Northumberland

was vital and was a risk worth taking.

It is worth noting that the clearance process was rather less straightforward

for the Trust who had to obtain clearance from the Treasury, the Department of

Health and Monitor, the sector regulator for health services in England.

The result was that Northumberland County Council approved a £114

million loan to Northumbria Healthcare Trust allowing them to cut their overall

borrowing costs for Hexham General Hospital and focus their cash where it's

needed most - in front line healthcare. It is expected that this will lead to savings

of about £3.5 million every year for the next 19 years.