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The NHS status quo must not be championed

Nick Golding

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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Readers' comments (3)

  • Roger

    'Service reconfiguration', is code for loss of local services. This might seem a relatively minor issue for those who can simply stay on the local bus, tube, tram or train for a couple of extra stops in order to go to the ne, bigger and better service centre for their appointment or treatment. This centralising agenda is completely overriding any consideration of the rural proofing agenda that both this and the previous government claim to be committed to.
    Accepting that small local hospitals are too expensive to run and unlikely to provide the best level of treatment available to the patient is the easy bit. However, this ignores the fact that poor transport will also prevent people from accessing the best quality treatment. When the patient lives in a rural area. Moving the treatment centre 60 miles away and calling it a centre of excellence, is of little comfort to a seriously ill rural dweller, when they may not own a car and have little or no public transport available.

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  • Nick Golding

    Hi Roger. I think the sort of service reconfigurations councils should support are those which bring most (but not all) services closer to people's homes. I come from a medium-sized town and know what it's like to travel long distances.
    However, specialised care cannot be safely provided if there are not the resources to have sufficient numbers of consultants in at all times. This is why death rates are far higher at weekends. For the most serious treatments you need bigger units.
    Here's a quote from a Health Service Journal article explaining how London's stroke strategy (which centralised services) has been successful:
    "Seventy-five per cent of London stroke patients were directly admitted to a stroke unit while the national figure was 39 per cent.
    "Seventy-five per cent of London hyper-acute stroke units achieved all seven standards for quality acute stroke care; the national figure was 7 per cent (based on 2010 Sentinel Audit figures)."

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  • I am a little conflicted by this. In principle I believe in a full and transparent consultation process and I know the NHS doesn't always demonstrate this. However, no local politician is likely to risk supporting actions that upset the elecorate even if those actions are for the greater good. No simple answers, it just seems to be an area where neither localism or central control is likely to work well.

    Graeme Dixon, LGC LinkedIn Comment.

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