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.

Re-think

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
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    Comment number 55.

    Yes. Investing in community based care would be expensive but the real question is; Who will pay? Nowadays that is always the question as every organisation involved tries to push the cost onto some other organisation.

  • rate this
    +2

    Comment number 54.

    Leeds is the 3rd biggest city in England with a population over 750K, add to that the surrounding population of Yorkshire and Humber you have 5.3million people. The decision would have meant people traveling 100's of miles on a regular basis for childrens heart surgery! Medical facilities need to be placed where the populations are, not making the populations travel to the medical facilities!

  • rate this
    0

    Comment number 53.

    We could have the best NHS in the world if it was not so badly mismanaged. They have had the money and misspent it. Why has nobody been called to account for the £12 Billion computer fiasco? Where has all the money gone? The NHS is being privatised at an alarming rate, We need to defend it now.

  • rate this
    0

    Comment number 52.

    In Blackburn Lancs they are trialing a GP led system in conjunction with the ambulance service. If you call an ambulance you will be assessed by the attending paramedic who will then seek a rapid assessment from an on call GP. who would then send you to the A&E for admission. or suggest you are treated in the community. The legal implications are massive for this system. not Good.

  • rate this
    0

    Comment number 51.

    When you are seriously ill the NHS is wonderful, unfortunately too many people abuse it. Now is the time to make drunks who make the A&E dept a no good area for the rest of us who need emergency treatment pay for treatment. I do agree that hospitals who specialise in certain aspects, where the Doctors and Nurses are trained in their area are much better as long as you don't have to travel too far

  • rate this
    0

    Comment number 50.

    Has the NHS's Head of Branding yet decided upon the method of branding that is to be used?

  • rate this
    0

    Comment number 49.

    You need to be more questioning in your analysis. To be sure, we can't have children's heart surgery on every street corner, but nor should we have one unit for the whole country, the logical end point of the 'bigger is better' argument. We need to base decisions on evidence, and the evidence does not support the proposals. Beyond a certain point, bigger is just bigger, only better is better.

  • rate this
    -1

    Comment number 48.

    NHS has to be one of the worst health care systems in the world,no wonder Britain is way behind other euro countrys

  • rate this
    +1

    Comment number 47.

    The lawyers have too much power in this country.

  • rate this
    +2

    Comment number 46.

    This Leeds hospital obviously dosn't care how much of our tax payers health service budget it wastes on this silly spat as long as THEY get what THEY want. This is exactly why the NHS is going down the tubes encouraged by a judge who can't make a decision of yes or no. The only people who win are the fat cat legal proffession.

  • rate this
    +2

    Comment number 45.

  • rate this
    +1

    Comment number 44.

    I'm having trouble working out what has the running of the NHS got to do with any court or any Judge. A simple business decision is all that is needed free from outside influences.

  • rate this
    +1

    Comment number 43.

    So another jr is going to cost the NHS and therefore the taxpayer probably several million with the resulting review of the original review of child heart surgery services because one group of patients/parents didn't like the result. What happens if the next group of patients/parents doesn't like the new result of the review? Why do one group think they are more important than any other group?

  • rate this
    +1

    Comment number 42.

    Another nice little earner for the "legal" proffession while the people who care get messed about again.

  • rate this
    +1

    Comment number 41.

    Our local BBC news is again raising the spectre of closure of the Southampton Unit.

    When will the "grown-ups" stop messing about and let the medical staff just get on with the jobs they love?

  • rate this
    +1

    Comment number 40.

    Zoonie @11
    As an NHS nurse for 37 years I utterly disagree with you. The NHS is packed full of individuals who want to put patients before targets but are prevented from doing so by the culture of the NHS.

  • rate this
    +2

    Comment number 39.

    Trout Mask @26
    In my area of district nursing we already do that. We continually get behind with inputting contact data (which the managers hate as this is the only evidence they have of the number of visits we do - apart from asking us of course). I simply say to irate managers patients will ALWAYS be our priority and suggest a clerical worker could input the data instead!

  • rate this
    +1

    Comment number 38.

    The fact that the decision to reduce the number of hospitals 'authorised' to perform heart surgery on children ended up in the Law Courts highlights some of the problems this country faces. There are far too many 'experts and advisors' who seemly make recommendations (decisions) - the final decision should be taken by our elected politicians, they (politicians) must stop passing the buck.

  • rate this
    +1

    Comment number 37.

    I live in rural Devon.

    I had a severe neurological illness that could only eb cured by surgery.

    It meant going to London to get it - there are not enough cases to have hospitals all over providing the requisite experience to be good enough to do it.

    I would much rather travel for great care than have OK care closer to home.

  • rate this
    0

    Comment number 36.

    11.Zoonie.
    It is finding politicians and managers that care more about patients than targets that is the problem.

 

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