THE BRISTOL HEALTH SERVICES PLAN

(or knowing the patient's health before examination?)

On Nov 8th, I and Dr James Briggs attended a public consultation meeting held by the North Bristol - South Gloucester Health Trust. for the Bristol Health Services Plan.

Below is a synopsis of the letter of response sent to the Trust, using its Summary Consultation Document. It might look somewhat cynical, but that was the conclusion we drew, and if there is one thing the Society is renowned for it is honesty! Our effort also shows how, with our limited resources, we try to get an overall picture of Bristol's likely demographic changes
(Actions v Reactions!).

The Society is a charity concerned, holistically, with the quality of the built environment, so covering historic buildings, traffic (including congestion and pollution), and civic design. These issues demand community involvement, therefore consultation must be meaningful . That aim cannot be met if either consultation does not precede the decision-making process, or, if the process is manipulated. We are not writing on specific sites, but on the weaknesses in the Consultation, which seems merely to table options, in order to count the number of people or press comments, so to allow the Heath Service to do what it wants.

TRAVEL AND TRANSPORT

Amazingly the consultation fails to identify and suggest a long term sustainable approach, to minimise the need to travel and focus on improved access by public transport (not everyone has a car or can afford taxis). For example, we disagree that the General Hospital is poorly located for access from South Bristol. Delivering services locally is essential. Also, retaining essential services at Southmead and Frenchay as well as at the proposed community developments at Kingswood, Thornbury and South Bristol, is beneficial. We believe this apparent lack of sustainability assessment is in breach of Good Practice preached by the Government and the National Health Service (NHS).

BUILT ENVIRONMENT

Hospital buildings have a dominant civic presence, so we are disappointed there is no start in the approach to properly assessing the existing Authority estate -- the asset value provided by the various listed buildings and those of character in Conservation Areas. You seem to think that old buildings are "simply no longer acceptable for modern health care" or are "prohibitively expensive to modernise", or, citing difficulties posed by the Disability Discrimination Act, reflect an inherent lack of imagination, and a dereliction of NHS duty. You should look at such buildings -- Bristol Royal Infirmary (BRI), Blackberry Hill, and Frenchay -- as historic assets on which to demonstrate good husbandry and ingenuity to overcome constraints and problems. The Commission for Architecture and the Built Environment (CABE) and others emphasise that the very character of the built estate makes a notable contribution to patient and staff well being. So we believe that any new development should build on the historic legacy and achieve high quality design. including adopting a "carbon neutral approach".

DESIGN AND FINANCE

The Document (12.2) focuses on services, whilst the primary control of major expenditure is located elsewhere. Since the cost of Design, Building and Commissioning together are less that the maintenance over the building's life, there is a need for sensitive and flexible design, to respond to changes over 30 years to ensure the built estate will retain its value. So the Authority must take firm control at Planning Stage to ensure each hospital is fit for its purpose (R. Moss, 1985 - "Designing for reduced operating costs"). Experienced medical staff have to be involved in the design from Day One onwards. This should avoid costly later design defects, minimise maintenance costs, protect expenditure flows and maintain the humanity of the NHS. We hope these comments are useful.

VISION

The stated vision needs enlarging. To the medical aspects of healthcare must be added the processes and impact on the wider environment (empowering users, high quality design, sustainability, reducing travel etc). We hope you will look into the above perceived deficiencies, and look forward to further participation.

Audrey Lennox
Chairman
Tel: 0117 950 0664


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