Why is everyone obsessed with making military hospitals pay their way. Open the hospitals and run them at a loss, don't take patients from the local area unless specifically requested to by the local health authority that way no local hospitals are adversely affected.
I've never seen anyone complaining that Trident doesn't pay it's way or Challenger 2 so why do we necessarily have to have Military Hospitals that do? Defence is about preparing for an eventuality and I think the present system would fall apart in a world war scenario.

Originally Posted by Markintime

Why is everyone obsessed with making military hospitals pay their way. Open the hospitals and run them at a loss, don't take patients from the local area unless specifically requested to by the local health authority that way no local hospitals are adversely affected.
I've never seen anyone complaining that Trident doesn't pay it's way or Challenger 2 so why do we necessarily have to have Military Hospitals that do? Defence is about preparing for an eventuality and I think the present system would fall apart in a world war scenario.

Because a working hospital isn't a building with lots of beds in it, waiting for a war to happen. It needs staffing with people who often have highly specialist skills that need constant practice, updating and development if they are going to do a decent job. They need to work together in teams in the same way as other military units do. That's rather more logistically difficult to arrange than people seem to assume when you are dealing with a population that is largely extremely healthy and geographically widely spread. The only way to achieve this on one or even a few sites is to generate a case mix from the local catchment area. That inevitably involve civvies, with the difficulties that brings , already exhaustively discussed above.

Technically you are right. We could have a military hospital as a money sink, not really doing the job it was intended for 95% of the time and struggling to maintain clinical standards. Believe me, with certain specialities, this was becoming an issue in the dying days of the military hospital system. However you spin the argument about the value of a nuclear deterrent or heavy armour, it's unlikely that the capabilities will be thrown away entirely as they still seem to provide a degree of value and utility. They cost shedloads but bring something tangible to the party. On the other hand we are coping without a military hospital. A new development, or even refurbishment of an old one, would be hugely expensive and massively impact on the rest of the DMS, let alone the defence budget. The main beneficiaries would not be military personnel or veterans, but the civilian population of Gosport, Aldershot or some obscure villages somewhere south of Swindon.

I am not claiming that the current system is perfect, but the medical chain stretches from the point of wounding to long after the individual leaves the services. Most sections of this process need attention and co-ordination between them certainly needs to be better. That is really where the effort should be going. I've yet to hear a solid argument for why we should put the clock back, beyond a feeling of nostalgia and a vague unease that the French may be looking down their noses at us.

Edited to add- How many military hospitals would we need for a world war scenario? Wouldn't we want to concentrate on a larger army, navy and airforce to fight it and draw up medical capability alongside that?

Originally Posted by Markintime

Why is everyone obsessed with making military hospitals pay their way. Open the hospitals and run them at a loss, don't take patients from the local area unless specifically requested to by the local health authority that way no local hospitals are adversely affected.
I've never seen anyone complaining that Trident doesn't pay it's way or Challenger 2 so why do we necessarily have to have Military Hospitals that do? Defence is about preparing for an eventuality and I think the present system would fall apart in a world war scenario.

The number of patients is currently so low that the current setup is the only safe way to maintain clincal competencies. Hospitals are so hugely expensive to run, something like £200-300million a year for one the size that Wessexman wishes to see with all the modern technology that the NHS uses, that it HAS to be financially viable and to fill its beds, otherwise it's just a money pit with no outcomes. Equally your doctors and nurses with nothing to do would quickly lose their skills.

I'm not even sure that the DMS could currently staff such a large hospital without removing all input from elsewhere, it certainly doesn't have enough consultants.

Obviously not - if DMS and AMS are not calling for it and they are the experts.

My understanding is that you need a large civilian hospital sat in a major centre of population in order to have sufficient patients on which the medical and nursing staff with allied professionals can develop and maintain their skills. The problem with the military is that we are largely a population of fit and well young (mostly) men. Selly Oak works (now that they have got a grip on some of the administrative and welfare aspects) because you have a superb set of professionals who can apply their skills to military casualties.

I wasn't aware that Woolwich ever had such a reputation, nor did CMH and MPH. From distant memory, they were dire institutions. I do remember my NI RMO advising me to always do my best to get any casualties into Belfast City hospital despite the security risks, because they were better.

Originally Posted by psychobabble

Originally Posted by Markintime

Why is everyone obsessed with making military hospitals pay their way. Open the hospitals and run them at a loss, don't take patients from the local area unless specifically requested to by the local health authority that way no local hospitals are adversely affected.
I've never seen anyone complaining that Trident doesn't pay it's way or Challenger 2 so why do we necessarily have to have Military Hospitals that do? Defence is about preparing for an eventuality and I think the present system would fall apart in a world war scenario.

The number of patients is currently so low that the current setup is the only safe way to maintain clincal competencies. Hospitals are so hugely expensive to run, something like £200-300million a year for one the size that Wessexman wishes to see with all the modern technology that the NHS uses, that it HAS to be financially viable and to fill its beds, otherwise it's just a money pit with no outcomes. Equally your doctors and nurses with nothing to do would quickly lose their skills.

I'm not even sure that the DMS could currently staff such a large hospital without removing all input from elsewhere, it certainly doesn't have enough consultants.

I understand what both you and Neuroleptic are saying but again I say that money shouldn't come into it, it should be a huge hole in the ground in much the same way that most of defence is. I seem to remember reading somewhere that the only part of the MoD that pays it's way is the Red Arrows so should we just have those and get rid of all the rest?
Clinical governance is important however and I take that on board, but there are ways round that either by rotating expertise round the odd civilian establishment or by acquiring patients, perhaps on a private basis or as overflow from the NHS. IT would be welcomed by the NHS as a way of reducing waiting list times and would not threaten NHS hospitals. You talk about skill fade but what happens now? If we can keep our doctors and nurses skilled in all the disciplines required of a doctor or nurse now with what amounts to a handful of wards why can't we expand it? If you build military hospitals with a major trauma capability, add on a spinal and burns unit and you have the potential to receive casualties from all over the UK just for the centre of excellence alone patients are flown all over the UK as it is to Pinderfields, Roehampton, Oddstock Glasgow because they need specialist care so why not have hospitals in the UK that not only have major experience of GSW and blast injuries but who could receive such injuries in a secure and protected environment which could adjust very easily to a heightened security.
I'm not saying having military hospitals would be easy they would need to be carefully (and expensively) run to ensure skill progression but then, in my mind, the value of a military hospital is beyond value.
In a WW scenario we are likely to lose most of the foreign workers who currently make the NHS possible. The NHS would not be in a position to deal with mass casualties and the best case scenarios would be centralising all those who meet the skill requirements and come from an allied nation then finding a suitable hospital to take over and adapt to military needs, my argument is why not create the hospitals now and give the whole Army that massive psychological boost and morale boost that goes with knowing there is a military chain of evacuation as far back as a base hospital and if they have to be discharged there is still a point of contact in a system they understand for them to seek help.
Where there is a will, there is always a way. It is just a matter of overcoming the obstacles, if you are struggling to meet a certain clinical discipline to hone your skills then send them to a civvy hospital or attach them to an allied Military Hospital who does have the necessary clinical expertise. If we do find ourselves in a European Army I doubt they will want European troops to have a country that doesn't have a Military Hospital.

Originally Posted by Markintime

In a WW scenario we are likely to lose most of the foreign workers who currently make the NHS possible.

Planning for World War??? FFS. You might as well plan for taking back the Empire.

Originally Posted by Bullshot!

Obviously not - if DMS and AMS are not calling for it and they are the experts.

This Government has a habit of foreshortening the career of anyone who asks for more, ask Sir Richard Dannatt

My understanding is that you need a large civilian hospital sat in a major centre of population in order to have sufficient patients on which the medical and nursing staff with allied professionals can develop and maintain their skills. The problem with the military is that we are largely a population of fit and well young (mostly) men. Selly Oak works (now that they have got a grip on some of the administrative and welfare aspects) because you have a superb set of professionals who can apply their skills to military casualties.

I wasn't aware that Woolwich ever had such a reputation, nor did CMH and MPH. From distant memory, they were dire institutions. I do remember my NI RMO advising me to always do my best to get any casualties into Belfast City hospital despite the security risks, because they were better.

The QE was considered one of the leading centres for post MI recovery and was heavily lent upon by the surrounding NHS. MPH was always set up as a field hospital the RVH (now the BCH) being the base hospital with far more resources than what was little more than an MDHU. In their day Military hospitals were very highly thought of and the standards of care, particularly the staff/patient ratios were considered far superior to the NHS with far more attention paid to the individual than is possible in an NHS which has skill shortages all over.

Being a centre of excellence is not necessarily the point. How many people, if given the opportunity to be treated in the world's foremost hospital for that particular ailment would still stay at the local NHS hospital with no particular reputation for excellence.
Selly Oak is a mini Military set up so obviously the Military can do it on a small scale so why do you think it can't do it on a large scale?

Originally Posted by Bullshot!

Originally Posted by Markintime

In a WW scenario we are likely to lose most of the foreign workers who currently make the NHS possible.

Planning for World War??? FFS. You might as well plan for taking back the Empire.

What on earth do you think we are for? Do you think we should just train to invade ME countries? I can just hear your grandfather, after WW1 saying, let's disband the military, we'll never have another world war now. Do you think Trident or Challenger2's are there for a Falklands or Gulf War?

Originally Posted by mnairb

Cold_Collation: I've taken on board your comments - see article below from Brighton Argus:

'A charity is being forced to cut costs and staff as its struggles to cope with the impact of the recession.

St Dunstan's, which cares for blind ex-servicemen and women, has already reduced its annual budget of almost £22 million by £2.6 million but says it needs to do more if it is to keep developing services to meet demand.

The charity, which has its flagship care home at Ovingdean, Brighton, currently supports up to 5,000 people around the country compared to 1,200 ten years ago.

It has done an extensive review of the way it works and brought in several cost-saving measures while also boosting its fundraising.

Now it has been forced to warn staff jobs could have to go while also introducing a recruitment and pay freeze.

One of the last surviving First World War veterans, Henry Allingham, who died last year at the age of 113, spent the last years of his life at St Dunstan’s in Ovingdean.

On average the centre cares for 100 people a day. Approximately a third of this number are permanent residents, like Mr Allingham, who receive nursing or residential care and another third are on holiday or receive respite care.

The remaining people live nearby and access the services daily.

Almost 200 people are employed at Ovingdean but the charity cannot say at this stage how many jobs could go.'

A more recent article from The Argus said that 1 in 6 of the staff would have to go. This topic certainly received coverage on both BBC South and Meridian local news. I agree, this is a scandal that should get a lot more mileage than it has had, being the only specialist establishment for blind ex-servicemen.

As mentioned in the article, Henry Allingham spent his last few years at St Dunstans and I find it particularly nauseating that Cyclops got a lot of publicity by getting photographed with him and made a point of mentioning in Parliament that 'he knew him', but is characteristically silent now that the home is in difficulties.

Maybe the journos that haunt this site in the search for juicy titbits to report could give this issue some 'oxygen of publicity'.

mcnairb, thanks.

I know the Argus - I live up the road near Gatwick and get down to the coast quite a bit - and it's good to see the story. But it still is only a local paper, effectively. I agree, it really needs to go national.

Media types, please take note.

(My comment might just have been a subtle 'bump'...)

Originally Posted by Markintime

Originally Posted by Bullshot!

Obviously not - if DMS and AMS are not calling for it and they are the experts.

This Government has a habit of foreshortening the career of anyone who asks for more, ask Sir Richard Dannatt

My understanding is that you need a large civilian hospital sat in a major centre of population in order to have sufficient patients on which the medical and nursing staff with allied professionals can develop and maintain their skills. The problem with the military is that we are largely a population of fit and well young (mostly) men. Selly Oak works (now that they have got a grip on some of the administrative and welfare aspects) because you have a superb set of professionals who can apply their skills to military casualties.

I wasn't aware that Woolwich ever had such a reputation, nor did CMH and MPH. From distant memory, they were dire institutions. I do remember my NI RMO advising me to always do my best to get any casualties into Belfast City hospital despite the security risks, because they were better.

The QE was considered one of the leading centres for post MI recovery and was heavily lent upon by the surrounding NHS. MPH was always set up as a field hospital the RVH (now the BCH) being the base hospital with far more resources than what was little more than an MDHU. In their day Military hospitals were very highly thought of and the standards of care, particularly the staff/patient ratios were considered far superior to the NHS with far more attention paid to the individual than is possible in an NHS which has skill shortages all over.

Being a centre of excellence is not necessarily the point. How many people, if given the opportunity to be treated in the world's foremost hospital for that particular ailment would still stay at the local NHS hospital with no particular reputation for excellence.
Selly Oak is a mini Military set up so obviously the Military can do it on a small scale so why do you think it can't do it on a large scale?

I have nothing but dreadful memories of military medical 'care' in the 80s. It was dire, I would have taken the NHS any day of the week.

When we owned half the world, military hospitals did make sense, because the services were big enough. there were sufficient patients and there was often no alternative.

Handy quote off Dannat, but it didn't stop him or many others continually asking for more across many fields.

More relevantly we have the announcement of the RRCs - which will make actually make a significant difference to the care of recovering troops.