Plan McAleer THE COMING months are witnessing a massive re-organisation of health service provision in the Bristol area and environs.
The background to these changes is the government's policies on health, but also the continue restrictions on public spending.
Single Trust In spring 1997 Avon Health Authority commissioned a report from the Sainsbury Centre for Mental Health, which recommended a large, single mental health trust.
In February 1998 proposals were put forward to form such a trust from existing mental health services provided, in the main, by general hospital trusts.
This will stretch across the main population centres of Bath, Bristol and Weston-Super-Mare, with an opening remaining to extend it further East towards Swindon.
Presented as an opportunity to provide better services and to ensure that spending on mental health services is defended/ring-fenced, the reality in the Suddenly run up to April 1 large deficits in 1999 is somecurrent budgets -different. Suddenly amounting to large deficits approximately 5 per in Cure E budgets cent of the total £55 amounting to million - were approximately 5 per cent of the discovered total £55 million were discovered. In an attempt to balance the budget the favoured approach seems to be widespread job freezes, leading in quite an erratic way to increased pressure on already overstretched staff. Acute beds had already been closed at one Bristol unit in April 1998, elsewhere elderly beds are under threat.
Ironically the Sainsbury Centre has produced a more recent report warning that the rush to form single 'stand alone' mental health trusts is often counter-productive, detracting attention from front line services.
In the wake of this a further merger has been proposed between Frenchay and Southmead NHS trusts in Bristol, again for April 1999. Glossy documentation has been published outlining perceived benefits in terms of larger specialist staff groups, reduced management costs and increased ability reduce junior doctors working hours to 56 per week.
The trusts have stressed that there will be no threat to A&E services on either hospital site; previous threats to this service having been vigorously opposed by local health campaigners.
Cover-up
However, in the current economic context, such re-organisation can, as the experience in mental health highlights, be used as a cover for extensive cutbacks.
Already trade unions in the trusts have found their respective managements giving wildly contradictory information about how the merger will effect the support and ancillary services. Unions have been offered and become involved in extensive negotiations over personnel policies and staff transfer to the new trusts. Important though this work is there is a danger of activists becoming exhausted in a myriad of committees with the underlyproblems of inadequate resources workers demoralisation and increasing pressure remaining unaddressed.