Behind the headlines – the positives of reconfigurations

Behind the headlines – the positives of reconfigurations

“Save our local hospital” is an oft-repeated phrase, heard every time the spectre of service reconfiguration, downgrades or closures are raised. 38 Degrees’ investigation of the recent NHS Sustainability and Transformation Plans (STPs) has led to headlines which focus on finances: the opportunities for the NHS to address its anticipated funding shortfall of £20Bn by 2020/21 by re-jigging its services. But are the reconfigurations and closures only about saving money, or are there clinical drivers?
The NHS is unique, and there is a national affection for the service, (allegedly) described by Nigel Lawson as “the closest thing we have to a national religion”, and expressed in the prominence of the NHS in the 2012 Olympic opening ceremony. As a result, any attempt to introduce substantial change is often viewed as an attack on the principles of the NHS itself.
On its formation in 1948, the NHS inherited an incoherent and uncoordinated mix of locally-funded hospitals developed through a mix of private enterprise and philanthropy. Thus its estate was (and, to a large extent, remains) an accident of history, rather than a planned solution to health needs.
There a reasonable case for change behind reconfiguration proposals, beyond financial expediency. Increasingly, healthcare across the world is becoming more specialised, leading to care being delivered in fewer, specialist centres – concentrating clinical expertise, to the benefit of patient outcomes and – incidentally – the cost of services. In the UK, the introduction of Trauma Centres, the centralisation of Stroke services and the increasing specialisation of paediatric services are clear examples of where fewer are better.
With a finite pool of highly-skilled, specialist staff and ever-tightening clinical governance regimes, specialist service delivery is now increasingly focused on regional and sub-regional centres providing a service that is safe and clinically effective. And if these services can reach out using telemedicine and technology such as Skype in place of a face-to-face consultations, is there really any loss to patients?
So before the public erect the barricades and politicians of all flavours stir up a froth of anguish in the interests of their own voter base, perhaps they should consider that the vast majority of NHS contacts take place in primary care – on patients’ doorsteps. Fewer than 1 in 4 of us are admitted to hospital each year, and then for an average of only 7 days for inpatients . And ultimately, which is better? A service that is clinically questionable, despite the best efforts of staff, but is near, or one which takes 5-10 minutes’ longer to reach, in an ambulance that is like a mobile Intensive Care Unit, and which provides expertise and skills that would have been unthinkable even twenty years ago? None of which is to deny the validity of 38 Degrees and others’ call for greater transparency about what looks like the first comprehensive NHS infrastructure plan since 1962.

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