The future of the Min. 


A few days before Christmas, when Out Patients is overflowing and governors are serving coffee to visitors round the Christmas tree, is not the best time for a Care Quality Commission’s visit to a small specialist foundation trust. But inspections happen and, although I have yet to see the formal result, I understand that again, the hospital’s colours are flying proudly. But almost the last decade the Royal National Hospital for Rheumatic Diseases in Bath [RNHRD] has been fighting its corner.


I am a patient with ankylosing spondylitis [AS] and psoriatic arthritis and there are currently research projects running at RNHRD and its associated research charity, Bath Institute for Rheumatic Diseases, into both of my conditions. The residential course developed and running here for AS is internationally known, and I was privileged to be among the group of patients and medics who founded the National Ankylosing Spondylitis Society at the hospital back in the 1970s. Rheumatology was established as a discipline here by Dr George Kersley in the 1940s and it remains a world-renowned centre for the training of rheumatologists.


Despite the pressures of the last troubled years since Monitor intervened at RNHRD, (known locally and affectionately as The Mineral Water Hospital or The Min for short) the hospital has continued to offer services repeatedly gaining the highest accolades following all CQC inspections. One of the first and the smallest foundation trust to be created, The Min started in profit and looked forward to a good future. But the weight of a foundation trust administration began to take its toll and then big governmental changes in commissioning and tariffsplus the national financial crisis weighed in.  


Within a few years the hospital was at risk. Monitor sacked the chairman and parachuted in another without any reference to governors (I was a patient governor at the time). The highly successful Neuro-Rehabilitation Unit, where “Locked-in”patient Tony Nicklinson had recently been treated, was axed. Now there is a threat of The Min being sold off to the Royal United Hospital Bath [RUH] with no guarantee of any effective mechanism for the preservation of The Min’s brand and mission and the administration of the unique research-linked high quality services continuing as they are.


In the face of such threats The Min has continued to create new services integrated with research and is currently a market leader in the treatment of Chronic Fatigue Syndrome. The latest development, in the care of post-cancer treatment patients, is proving yet another great move forward in treatments that balance education and a psychological approach with drug therapies, and staff morale throughout the hospital stays high.  Even its catering won a recent award.  But the threat of merger of this small specialist national hospital with a local large general hospital looms ever closer and no jobs are secure.


The acquisition by the RUH of The Min provides no guarantees that any of the current services will either continue or function as efficiently as they currently do. I believe that the aim must be to preserve the integrity of current imaginative and forward-thinking research-led clinical practices, so well integrated with a dedicated therapist team that functions so well and delivers the highest quality of patient services throughout this long unstable time. No one can yet explain how the brand, quality and reputation of The Min can actually be preserved, protected and managed in these conditions.


At the Annual Members’ Day of the RNHRD on December 12th 2013 it was confirmed that there is only one tabled plan – that of acquisition by the RUH. Members heard the RUH management make fine statements about respecting and preserving the brand and reputation of The Min, but then they said that there are no plans for the future governing body of the RUH, if and when it becomes a foundation trust, to include any representation of The Min.


Over the last financial year The Min has made considerable savings and this is a positive signal. Another is that starting in February this year, the new Refresh initiative to reconstruct and refurbish outpatients, using charitable funds collected over the last two years, shows confidence in the building and what it can provide. The joining of charitable funds, national heritage funds and a large local and national initiative to preserve, reconstruct and develop could and should be the way forward rather than any relocation and new-build. Had the hospital been failing in any significant medical way, the story would be different, but it cannot be a wise and cost-effective strategy, in the longer term, to dismantle excellent services and risk losing such excellence and international reputation through redistribution and fundamentally detrimental management changes.


The threatened removal and atomisation of The Min from its historic central site into new-build, somewhere on the out-of-town RUH site as yet unspecified, could be catastrophic. It has been a national hospital specialising in rheumatic conditions since 1742 and should remain so. Both patients and staff find the small building size works well for delivering care and professional contacts. The supporting physiotherapy team, if merged into a larger team, could lose its specialist knowledge and the unusually sensitive respect for and liaison with senior medical staff that currently exists. The inevitably more impersonal and ‘treat it and beat it’ policy, necessary in a general hospital, is not appropriate to support long-term rehabilitation of those with complex chronic disorders. The fears of patients are exacerbated by the many years of uncertainty and unfulfilled assurances that all patient services will be preserved. The recent demise of the high quality Neuro-Rehabilitation Unit stands as a stark warning.


Bath is a Spa town, and until the 1970s was an internationally-known treatment centre based on the natural hot springs. Until then The Min’s hydrotherapy pool was also fed from the hot springs and the conduits, installed at great expense and granted through parliamentary permission, remain. The new Thermae pools and the soon-to-open Gainsborough Hotel with its own feed from the hot waters, will lack the medical treatments in an associated hospital provided in nearly all other European spa towns.


A new and positive vision is now needed in liaison with some creative and imaginative investors. In the long term it makes far greater sense to refurbish, reconstruct and redevelop what is there; rather than risk losing the impetus and creativity of what now functions so well, through new-build, relocation and new and more remote directorial and management responsibility. Or is this just a case of asset realisation and forcing The Min into a modern hospital monolith culture dictated by central government?


George Odam


Emeritus Professor Bath Spa University

Fellow of the Guildhall School (Retired)

Committee member, Friends of RNHRD