More money........

It has been a hectic week. We have had 2 public meetings so far, the first in Thirsk and the second in Hawes. It was good to be able to go out and meet people and explain to them directly the challenges we are facing as a community.

And of course we got to talking about money. No, the issues around maternity and paediatrics at the Friarage are not about SAVING money or cost cutting. But every issue in the NHS will have money in it somewhere.

One of the options we are looking at would require extra investment of considerable magnitude and that would be hard to find, because there is no NEW money in the system so to put it into these services would mean taking it from somewhere else. So then we have a series of questions:

          Where do we take the money from?

          Who makes that choice?

If we assume every service needs the money it has right now to function and would probably be able to be better if it were given more money, how do we decide?

There are services that are less “popular” or politically sensitive (less people to complain if we took money away)  but often these support our most vulnerable and disadvantaged and we have a duty to care for them.

We don’t have the answers. Only more questions!  If by some miracle we were to be given the money we needed to do this, would that be the best use of the money?

Going back to talking about the overall NHS funding issues:

North Yorkshire as a community has spent more on health care than it has been given for years. Last week I wrote about the funding formula and this is probably the reason we don’t cope within the money we are given, but the bottom line is we have to find a way to live within our means. Over the last few years the PCT has balanced it books each year by what is called “non recurrent means” which really means by borrowing from other wealthier PCTs by asking them,for example, to pay a bill on our behalf by being given a loan. The problem is that then that loan becomes the first call on next year’s money, and then we have to borrow again to pay that back and so round and round we go.

To change this we think that we have to change the system in a fundamental way. We know that people would prefer to have their health care as close to home as possible. We also know that hospital care is the most expensive. We think there are people in hospital now who could, with the right help and support, be at home or in a local community hospital. We want to invest more in community services like district nurses and therapists, then work really hard to keep  people out of hospital by taking care of them locally.  We also want to get those who do go into hospital out as soon as possible and care for them near or at home.

It sounds easy, doesn’t it? But believe me it is more complicated than it seems.  Doctors and nurses need to work differently - maybe in different places, learn new skills, make new working relationships.  It can take longer than a year and during that time we might need to put extra money in to get it all set up whilst the old system is still churning on. Somehow we never seem to get enough time to do that. But we are going to try.

There are two more meetings next week: one in Colburn and one in Richmond. I am sure I will have more money conversations. Many people think we should pay for the extra staff to make the in-patient service safe to continue at the Friarage, even if that is an “inefficient” use of money (lots of doctors employed to work with very few patients) and won’t necessarily make the service future proof.   Maybe we should.  If we did, we would need more money so we don’t have to stop doing other equally important things.  The only solution seems to me to be a political one. There is no funding in the national allocation formula to address the issues caused by rurality. This is an issue about rurality.  I am not a politician.  I am a GP.  Maybe our politicians can find an answer.