Most of the community/cottage hospitals in the UK were founded around the end of the 1800 century, first quarter of the 1900.
This was because of a growing public consciousness of the need to improve the health of nation. It was also expected that family and communities would provide and care for their own. At this time hospital health services were mostly the domain of the rich, who could travel a far to access them.
Horsham Town Centre is called the Carfax meaning the merger of five roads, all leading to bigger larger towns within 18 to 25 miles, all with larger hospital services.
Horsham was an ideal place to build a community hospital, to serve its local rural population. Horsham Hospital is and has been a local cottage community hospital, serving its local community of Horsham town, its rural towns and villages.since 1892.
Community Hospitals became rooted institutions in their communities, like local schools churches pubs and post offices; they brought a bonding of community spirit that fostered self-reliance and sustainability.
At the introduction of the NHS community hospitals were at their peak, many providing A&E and Maternity services, however towns with bigger hospitals were developing into District General Hospitals (DGH), offering a full range of cradle to the grave health services, for larger populations.
Many Community Hospitals were asset stripped of their services and closed, or drastically downsized. In the 1960s-’70s-’80s Horsham Hospital became a football, coming under the management in turn of the different local health authorities mostly that of Mid Sussex (Brighton) then of Redhill (East Surrey). Horsham Hospital was always overlooked for expansion in favour of other local hospitals like Crawley, Haywards Heath, and Worthing. Horsham Hospital was asset stripped of its services in turn by all the health authorities, to fund services for our population elsewhere, undermining our ability to care for our own locally.
Then came the swift advancement in medical science and treatments making some services so specialised they could only be delivered in regional and national centres of excellence. Other advancements in drug therapies and treatments resulted in populations living longer, often with chronic long-term conditions, making it more possible to manage these diseases at home or locally within Primary Care (GPs) with less DGH visits. This in turn has lead to large DGH delivering fewer and less comprehensive services, making them less sustainable as DGH. This sort of centralisation of specialisation is still gaining pace lately to include services such as trauma A&E and children’s heart surgery.
Over the years there have been many reorganisations in the health service, one being Trust and Foundation Status for acute hospitals and Primary Care Trust for primary and community services. In 1993 Horsham Hospital joined Crawley in becoming Crawley and Horsham NHS Trust. It was proposed in the development of the Trust health services for Horsham Hospital that the Minor Injuries Unit (MIU) hours be extended, a new outpatients department, and a day surgery unit be built as the more acute surgery were to be done at Crawley. In the event, a new-build out-patient department happened, but the extended hours for MIU never happened. Day surgery developed in Crawley Hospital with the more acute surgery subsequently going to Redhill and the new Princess Royal Hospital in Haywards Heath. Crawley Hospital was downgraded to a community hospital after it merged with Redhill Hospital and formed the Surrey and Sussex NHS Trust and it’s 24x7 A/E work moved to Redhill. Crawley though retained a 24x7 Urgent Treatment Centre.
In 2009 the West Sussex PCT carried out a review of health services in the North East of West Sussex, though it ruled out a new acute hospital build, the review did make 45 recommendations. Amongst which was the recommendation 30 to extend opening hours for MIU at Horsham Hospital.
It surely should not come as any surprise that the centralised emergency A&E services are now near breaking point, especially out-of-hours and at weekends, if recommendations outstanding of 20 years to extend non-emergency out of hours service like minor injuries have not been implemented.
At a time we have had a local growing population, with new housing etc. and a population that has also been living longer, with more complex needs, with reduced mobility and ability to be able to access health services. (Horsham District has the fastest growing elderly population in West Sussex)
Another reorganisation of health services took place in 2010, with the demise of PCTs and the formation of local GP lead Clinical Commissioning Groups, being responsible for commissioning local health services for their local populations. So we have now come full circle for now in a time of austerity we are needing to care more for our own in our own communities, to make health services for the future more sustainable.
To do this local communities especially in the more rural areas of the county will need their local health support facilities like GP practices, Health Centers, and Community Hospitals more then ever and for local communities to work together and become more self reliant.
There is no new NHS money to invest here only the savings made in redesigning services to reduce costs in the acute sector, that then can be reinvested in local services.
There is a review-taking place of the health services at Horsham Hospital, to ascertain how this facility can best support the redesigned local health services
In the new health bill it states ‘no decision about me without me’. So it is now more important then ever for you to make your views known about local health services.
Join you local GP patient reference or participation group, and or join a patient advocacy grouping or charity to participate in the redesigning of local health services, including those at Horsham Hospital.