Bourne Comment

WAITING TO SEE THE DOCTOR

A deeply disturbing story recently appeared in the national press revealing exactly how serious the problem is with patients trying to see their doctor.

In years past it was an easy task to obtain an appointment which was always within a few hours but those days have long gone and now it may be two, three and even four weeks before a consultation is possible and as most patients only go when their medical problem has become pressing, the condition is likely to worsen in that time and when it does there is no alternative but to call an ambulance. This transfers the responsibility to the hospital whereas it should have been dealt with by the general practitioner.

Shortly before Christmas, a long queue formed outside the health centre at Sunbury, Surrey, at 6.30 am with more than 30 men and women standing shivering in the cold in the desperate hope of seeing a doctor, their only hope of a same-day appointment or face a wait until the New Year. The photograph published on the front page of the Daily Mail (December 23rd) was one that shamed Britain, said the newspaper, yet similar situations are being repeated throughout the country every day.

This is at the very heart of the problem with the National Health Service which is facing a crisis of monumental proportions aggravated by the Labour government’s changes to the contracts of general practitioners in 2004 allowing them to opt out of providing care outside office hours, thus ushering in the nine to five, five day a week regime that we are currently experiencing.

There is another major factor that has probably exacerbated the problem and that is centralisation which has robbed us of our small cottage hospitals, first line medical care available at the very heart of our communities where speedy and efficient service was dispensed at the point of contact without the need to wait for weeks or travel long distances for an appointment.

Bourne is a typical market town and the first hospital available to the public was established at the workhouse which opened in what is now St Peter’s Road in 1836, a facility designed for the inmates but also open to members of the public in times of serious illness. In 1930, the workhouse was converted into a hospital specialising in mental illness which continued in use until it closed in 1992 and a few years later the building was demolished.

The spread of infectious diseases during the 19th century, particularly smallpox and cholera, resulted in the establishment of a fever hospital at two converted cottages in Manor Lane in 1885 followed by our first cottage hospital, the Butterfield, which opened in North Road in 1910.

By 1915, the Fever Hospital was in need of replacement and Bourne Urban District Council built a new hospital in South Road, originally intended for patients suffering from infectious diseases such as scarlet fever, diphtheria and typhoid but from January 1918, cases of tuberculosis were also admitted and it soon became evident that separate accommodation would be more desirous for these patients and in 1925 a special pavilion was built within the grounds.

The building was regarded as one of the finest of its kind in the country, a single storey with a south western frontage close to the main road and containing four single bed wards and four double bed wards with a recreation room for each sex at either end and quarters for the nurses in the centre. There was also a spacious veranda and the entire building was heated with hot water radiators.

Eleven of the 12 beds were occupied within a month of the opening and during the first seven years of its existence, 224 patients were treated, of whom only 54 died. In the ensuing years, the isolation hospital was converted entirely for the treatment of chest conditions. Smallpox cases however, were excluded and in November 1930 an arrangement was entered into with the Peterborough Corporation to send such patients to their isolation hospital at Fengate.

It was through this early co-operation that the present system of health administration for Bourne began and although geographically in Lincolnshire, the hospital was taken over in 1949 by the Peterborough Area Health Authority which also controlled the Stamford and Rutland Hospital. While the Bourne Hospital was open, this system operated to the disadvantage of local residents who were often sent for advanced treatment to Peterborough while patients from Peterborough were sent to Bourne.

Centralisation, therefore, has been at the very heart of our present problems through the closure of our hospitals, first the Butterfield after nurses and members of the public turned out in force to protest and 6,000 people signed a petition demanding that it remain open. But financial restraints and a streamlining of National Health Service resources eventually sounded the death knell and it closed in 1983.

This was followed by Bourne Hospital despite another vigorous protest campaign by local people who raised a petition containing 8,000 names to keep it open but the battle was eventually lost in September 1998. The premises were left standing empty for the next five years before being demolished and the four acre site has since been used for new houses.

A search through the records of these two hospitals provides evidence of how valuable they were to the community, both within easy reach for people living in town and village. In 1965, for instance, the Butterfield was maintaining twelve beds in three wards, one male, one female and one private. There were five full time nursing staff and four part time with a further four employed on night time duty and there were also four kitchen staff and a porter. Minor surgery was performed in the operating theatre and the hospital also had a busy casualty department while weekly clinics were held by visiting consultants.

Bourne Hospital had an even more impressive record. By 1965 it was being run as a medical and surgical unit with 53 beds, two consultants and a medical officer, a matron, nine day and night nursing staff, four kitchen workers and a porter. There was also a chest X-ray unit which was used by the town and district and a domiciliary nursing service consisting of two sisters trained in midwifery, ante and post natal work, a health visitor and a medical officer of health, attending to around 60 cases a year and making 200 visits each month. The service was also responsible for clinics specialising in the eyes, orthopaedics, remedial and relaxation therapy and child welfare. All of this in a town with two existing family doctor practices and a population of 5,337 (1961 census), one third of what it is today.

Medical standards have improved and treatment is far more efficient but it can hardly be called progress to wait three weeks to see the doctor or to face a round trip of 35 miles for a hospital appointment and then the nightmare of car parking with the added burden of exorbitant charges. Furthermore, centralisation has destroyed the personal nature of medical treatment that was often seen to be part of the cure, that doctor patient relationship epitomised by Dr Finlay in the popular BBC Television series from half a century ago.

Unfortunately, governments do not learn from past experience and repeatedly use financial expediency as an excuse for improvement with the result that the current debate in the news and social media indicates that the privatisation already manifest in many aspects of our hospital administration may well spread to other areas of the National Health Service, a move that will isolate the patient even more from the personal care that was so readily available from their own community in the past.

Health care is moving in a new direction, one that is motivated by money. We have already seen with the instance of patients queuing for an appointment in Surrey that ill health does not keep office hours and the nation will soon learn that the healing of the sick does not sit easily with the pursuit of profit or personal gain.

Note: This article was published by the Bourne web site on 14th February 2015