Closing NHS services: the impossible job?

NHS logo The medical profession has argued expert care needs to be done at fewer sites

The verdict over child heart surgery in Leeds is just the latest twist in a long-running fight over the future of this complex area of care.

The debate has been raging for over a decade and has already been subject to legal challenges - a perfect illustration of why changing the NHS remains an incredibly difficult task.

The medical profession is united in the belief that expert care needs to be offered at fewer sites.

Child heart surgery is the prime example of that. It is one of the most complex procedures undertaken by the NHS with just 3,600 operations carried out each year.

To provide a uniformly high quality and safe service operations in such fields must be concentrated at specialist sites, it has been argued. Evidence shows this helps doctors improve skills and share expertise.

But the push for change is not just confined to child heart surgery. Similar debates are going on over everything from A&E units to stroke care.

The problem is reorganisations come at a price: the loss of services from much-loved local hospitals.

The strength of feeling displayed in Leeds - mirrored in south London, where campaigners took to the streets a month ago to oppose the downgrading of Lewisham Hospital's A&E unit - is testament to that.

These are difficult decisions and, with money getting ever tighter in the health service, expect more disputes in the future.


So where does the NHS go from here?

In terms of child heart surgery the verdict could be appealed by the Joint Committee of Primary Care Trusts, which has coordinated the review.

This happened when London's Royal Brompton Hospital won a legal challenge two years ago. The Court of Appeal subsequently overturned the verdict.

People marching in Lewisham The decision to downgrade Lewisham's A&E unit prompted outrage

As for the wider issue, some believe there needs to be a complete recalibration in how we view hospitals.

One of the biggest advocates for this is the NHS Confederation, which represents health managers.

By coincidence it has published a report on Thursday calling for a re-think in how services are organised.

It suggested large hospitals should be reserved for those with life-threatening conditions or needing complex care instead of being a dumping ground for the sick and frail.

Jo Webber, from the NHS Confederation, said: "Changing how we think and respond to circumstances is never easy, but never before has the scale of change required been like that currently facing the health and social care system.

"For too long, the default setting when we think about health care or support is to think of a hospital. But in reality, acute hospitals - whether major teaching sites or local district generals - are rarely the best place for someone who needs ongoing health or treatment."

This, of course, would require a big investment in community services first.

And perhaps that is the key. One of the most successful reorganisations of recent years was to London's stroke services.

Traditionally, care was provided from 30 hospitals, but after changes in 2010 emergency care is now provided in eight specialist centres.

Instead of simply shutting the other 22 bosses in London made sure they invested in rehabilitation services - some at the existing hospitals, some at new facilities - close to people's homes so that the public knew there would still be services available locally.

The changes were introduced with limited resistance. Some would argue that such change is easier to achieve in the capital where distances between sites is shorter - and that maybe true.

But the idea of good communication and investing in community-based services early are principles many would agree could help wherever changes is taking place.

Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

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  • rate this

    Comment number 35.

    #34 does that make sense even to you? If anything lots of smaller units with more variable survival rates would be more suited for 'experiments' than a few big units with far more staff to be potential whistle blowers. Do you think Shipman could have got away undetected if he wasn't running a single doctor practice?

    In actual fact what you suggest is grossly offensive.

  • rate this

    Comment number 34.

    Quote "One of the biggest advocates for this is the NHS Confederation, which represents health managers." Have they done such a good job? and "The medical profession is united in the belief that expert care needs to be offered at fewer sites" Not all of them by far, but some top surgeons/ clinincians who would like the few big teaching hospitals as a useful breeding ground for experiments.

  • rate this

    Comment number 33.

    The statistics clearly show that with complex procedures the more a hospital does the better the outcome for the patient (experts learn from each other). Unfortunately most people don't allow a little thing like facts get in the way of a good old misdirected emotional outburst and hence we have this. Personally I want the best possible care I can get even if that means I've got to travel a bit.

  • rate this

    Comment number 32.

    The only bad experiences I've had in the NHS are due to lack of staff or uncaring/overworked staff. Our son was in neonatal 2 years ago; the care and attention he received was excellent. They have a specialist nurse who loves their job for every few babies and many doctors.

    The same can't be said for the normal maternity ward which is like a conveyor belt with angry midwives barking at people.

  • rate this

    Comment number 31.

    embedded services in a particular location will have an historical reason as to why they were there in the first place. A strategical approach cannot always allow for this. Past history at Bristol and Oxford has shown that parochial consideration must not interfere with a review process at all levels. where specialist units have in the past been closed there has always been a good reason for it.

  • rate this

    Comment number 30.

    29. josy
    How can hospitals be in administration, when NHS is a not for profit organisation?
    By spending more than they receive in income. The hospitals don't have unlimited funds and healthcare is expensive to provide.

  • rate this

    Comment number 29.

    What the UK needs is for another political party to be setup consisting of no previous politicians in it, to represent the working population who earn a normal wage! We are governend by bunch of never do wells, playing games with our lives, knowing it makes little difference to them & their families! How can hospitals be in administration, when NHS is a not for profit organisation?

  • rate this

    Comment number 28.

    Doing something that is wholly unnecessary solely for the sake of dogma is impossible, by definition.

  • rate this

    Comment number 27.

    NHS services need to be where the population is - asking people from West Yorkshire to go to Newcastle is like asking Londoners to go to Leicester, Birmingham or Bristol. Yorkshire has a population equivalent to Scotland and double that of the North East. There should be no question of closing a unit serving such a large population.

  • rate this

    Comment number 26.

    The select committee should have asked David Nicholson: "If a nurse is interrupted by a call from a patient whist she's busily entering that day's target data at the Nurse's station, what should she do?"

    There is, of course, only one acceptable answer but the nurses of the country (and the managers demanding target data) need to hear it loud and clear from the man at the top.

  • rate this

    Comment number 25.

    The reforms introduced by the Labour Government in 1999 were intended to reconfigurate Hospital Services and decant some into the Community.

    That objective was totally lost despite a massive investment.

    I was the the Lay Member on the SE Sheffield PCG and in my opinion, the vested interests within Hospitals were the main stumbling block and continue to be so.

  • rate this

    Comment number 24.

    I can cure the NHS, just put me in charge of border controls and the removal of illegal immigrants."

    The slight flaw in your "cunning plan" is that applying for housing, registering your children at school, registering at a GP or turning up at A&E for treatment are not exactly great ways for illegal (the clue is in the name) immigrants to remain undetected.

  • rate this

    Comment number 23.

    #21 My wife does clinical admin for the NHS but is employed by the private sector. She's 'more cost effective' because she's paid, pensioned and sick paid far less than her NHS equivalent. Her company keep the difference and call it 'profit'. They're better off, she isn't, the tax payer isn't.
    Any organisation making a profit is unlikely to be more cost effective than one which doesn't.

  • rate this

    Comment number 22.

    In all fairness to migrants & health care, if they are carrying diseases like HIV, TB & other infection diseases, you want to treat them or the local population will be infected & cost as much to treat. The other point of note is the the NHS only functions because of the various nationalities who work in it. If we are happy to accept them working here then they should be eligible for treatment!

  • rate this

    Comment number 21.

    'The private sector is more cost effective'???
    Perhaps, but only when kept in the private sector. Every other privatisation or part privatisation of public services has been an utter disaster for the taxpayer and a party for successful bidder.
    If we're not careful we'll end up like the US - rich doctors and a sick population.
    Pass me the very buttery bacon sandwich, I'm going to save some money.

  • rate this

    Comment number 20.

    That's if you can get outpatiens services still - with the population growth obviously more people pay NI but there are no additional services - a four months wait for physio when you are in agony now is totally unacceptable. Millions are wasted on sick pay that would not be necessary if people were treated fast, millions that could be spent on the NHS instead to close funding gaps.

  • rate this

    Comment number 19.

    I bet my namesake is sulking at the moment, as he didn't get to privatise the NHS this week.

    Hopefully he's still also sulking after his failed attempt to allow his pal Murdoch to buy BSkyB.

    Only two years now till the election.....

  • rate this

    Comment number 18.

    I agree that we should be considering the idea because it does make sense, but if patients have to travel hundreds of miles for their specialised treatment, it will cost more, rather than less because the NHS will have to pick up the cost for providing ambulance to & from specialist centres. This has happened with patients travelling from Scotland, Wales; costing £200 at least each way!

  • rate this

    Comment number 17.

    #16 The NHS has a budget of approx £110bn a year. The amount lost to health tourism is estimated to be in the tens of millions. How many 'illegal immigrants' do you think are in the UK (note anyone from the EU is by definition NOT illegal) because for your ludicrous claims to be true it would have to be tens of millions!

  • rate this

    Comment number 16.

    I can cure the NHS, just put me in charge of border controls and the removal of illegal immigrants.

    As a consequence your children won't fight for places in school or even housing and there will probably be a job for them when they leave school.
    Win Win.


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