Will choosing not to significantly invest in St Mary’s Hospital during 2021 prove to be a very costly mistake?

At the beginning of any year it is always good to stop and reflect. 2020 has been a truly torrid year right across our NHS.

The long history of cuts by successive governments in the quest to achieve greater and greater savings has dramatically exposed the precarious fragility of the service when faced with events outside the norm.

Our IW NHS Trust is fortunate in having an executive team with impressive experience honed in much larger hospitals and trusts.

In the quest to provide the best clinical outcomes for patients it is quite understandable they see the value of enlisting the services and expertise that much larger health providers can offer.

Delivering health care on a larger scale has both clinical and economic benefits. Plus there are additional vulnerabilities that can disproportionately impact smaller hospitals and trusts which need to be carefully considered.

One of the biggest costs our NHS faces, which is rarely talked about, are the astronomical costs associated with medical negligence claims.

Sadly accidents happen, and when they involve children and young adults, settlement costs can run into many millions.

While hospitals do not meet these costs out of their own budgets there are nevertheless huge implications when it comes to the cost of annual indemnity premiums for medical negligence cover, which larger hospitals, with much bigger budgets, can more easily manage.

Outsourcing more and more services to other providers and partners places this liability onto their shoulders, and is a commercial factor many small hospitals are having to increasingly embrace.

But here is the problem when choosing to downsize rather than upsize and upskill.

St Mary’s currently has 961 patients awaiting elective surgery. With Covid-19 protocols, surgery times have increased resulting in fewer operations being carried out.

From the beginning of the year up until and including the month of November St Mary’s conducted a total of 2,735 day surgery operations, plus 160 private-funded revenue earning operations.

In January 2020 there were a total of 534 day surgeries operations, in October, when the Island’s Covid-19 infection rate was relatively low, 414 day surgery operations were conducted.

Despite the trust offering to pay for patients to receive privately funded operations on the mainland, only one patient was treated privately on the mainland during this ten-month period.

Given the present capacity in St Mary’s it is difficult to see how waiting lists are going to come down, indeed, without significant investment to expand elective surgery capacity, waiting lists and times are more likely to increase.

Initiatives such as working weekends will obviously help, but they are unlikely to make up for the shortfall.

Will the costs our trust faces begin to significantly rise if it chooses not to invest and expand capacity to meet clinical demand? As more and more patients wait longer and longer for elective surgeries with medical conditions that are deteriorating, will the trust find itself increasingly embroiled with exasperated patients and their families choosing to pursue, ‘no win, no fee’, medical negligence claims for delayed treatment?

Settlement costs are likely to far out strip what it would cost to invest in staff and services to meet demand.

Perhaps it is time to radically rethink the way ahead?

Let’s see our IW NHS Trust lifted from the crippling burden of ‘financial special measures’, an end to the soft bullying tactics of trying to keep patients away, and our hospital adequately funded so it can meet the medical needs of our community, when appropriate, here on the Island.

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