It is time for brave local leaders to admit that sometimes district hospitals will decline, says Nick Golding.
The move to restrict councils’ ability to oppose NHS service reconfiguration emphasises the cultural differences between local government and the health service.
While NHS decisions have traditionally been made behind closed doors, and then thrust upon an unsuspecting public, councils have an ingrained culture of robust political debate. The party political nature of local government ensures plans are challenged at an earlier opportunity.
It was therefore welcome that, by setting up health and wellbeing boards, last year’s Health and Social Care Act gave local government an apparently integral role in health decision making.
Council health overview and scrutiny committees have also, since 2002, had a power to refer local NHS decisions to the health secretary if they believe the public consultation process has been inadequate or the move is not in the interests of residents.
It is this power that was threatened by the comments of one of the NHS’s most senior leaders last week. Sir Ian Carruthers, the chief executive of NHS South of England who is undertaking a national review of NHS reorganisations, said that he was likely to recommend a new system in which councils’ objections must be based on evidence that plans do not meet one of four “tests”.
Opposition would only be permitted on the grounds of: safety; patient choice and engagement; clinical evidence; or support of clinical commissioning groups.
Could a council therefore oppose a reconfiguration on the grounds that local residents would have to travel too far for treatment? One could legitimately believe the concept of patient choice is something of a red herring in the health service – most people automatically opt for treatment close to home – but still consider long journeys undesirable.
Reconfiguring services in a manner which threatens links between hospitals and social care providers could potentially no longer be grounds for objection. And that would also appear to be true of objections based on cost – and there is no consensus that larger hospitals are necessarily more efficient.
However, there is a wider issue that councils must consider. Is it right that so many NHS resources are soaked up by district general hospitals too small to specialise in care for people with complex conditions, but too large and impersonal to care for older people with dementia who fill up an ever greater proportion of hospital beds? The answer to that question is emphatically ‘no’.
While residents will generally support the retention of all services at their local hospital, it is the job of councils to consider the bigger picture. It is time for brave local leaders to stick their heads above the parapet and recognise that sometimes district hospitals will decline as specialist care moves to a more regional level and routine care shifts to the community.
At a time when NHS funding is safeguarded, for councils to campaign for the survival of an outdated and often inefficient NHS model centred around district general hospitals makes a mockery of their own financial predicament.
Nick Golding, acting editor, LGC
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