The government’s health reforms risk making hospital reconfiguration more complex potentially hampering efforts to improve services and find some £20bn in efficiencies over the next four years, thinktank the King’s Fund has warned.
It called this week for ministers to take steps to de-politicise the process of hospital closure to avoid “protracted and sometimes hostile local reconfiguration debates”.
One example cited by the think-tank is Enfield LBC’s long-running battle to maintain Accident & Emergency services and maternity services at the borough’s Chase Farm Hospital.
Having previously sought a judicial review over reconfiguration plans, the council this last week called on prime minister David Cameron to protect the services.
The report argues that while the introduction of council-based Health and Wellbeing Boards has the potential to improve public engagement in the process of changing local services, health professionals should not underestimate the extent to which the public and local politicians found it hard to accept change.
In particular it argues that the current system for driving through reform made it hard to lay out a clear case for change in health services and allow councillors on overview and scrutiny committees to refer proposed changes to the secretary of state on the grounds they are not in the best interest of local communities.
As part of the proposals for de-politicising reconfiguration, the King’s Fund is calling for the introduction of new Care Quality Commission minimum standards that would prevent hospitals from providing services in areas where they were failing, driving change from the bottom up.
It also wants to tighten up the remit of overview and scrutiny committees to look only at the quality of public engagement on hospital closure, rather than the arguments themselves.
Report author and King’s Fund deputy director of policy Candace Imison said that in some parts of the country changes to the way hospital services were delivered were a necessity and ways to speed up the process – and to prevent politicians from blocking the process - had to be found.
She said that one option to speed up the reconfiguration process could be to establish independent panels to look at region-wide proposals in areas such as London, and to impose mandatory time limits on the amount of time by which decisions could be delayed if they were referred to the secretary of state.
“We don’t feel that the health bill addresses these issues adequately,” she said.
Caroline Tapster, chief executive of Hertfordshire CC, said she believed that the involvement of health and wellbeing boards would improve engagement with the public over health-service reform.
She said that elected members, doctors, and council officers working together with the public on reconfiguration plans would increase local buy-in.
In comparison with the way that plans have been formulated in the past by PCTs and SHAs I think we will have a very transparent process,” she said.
A Department of Health spokesman said ministers agreed that reconfigurations should be based on quality, safety and efficiency “with decisions underpinned by strong public engagement”.
“Our aim is to put patients, carers and local communities at the heart of the NHS, shifting decision-making as close as possible to patients by devolving power to clinicians, liberating staff from top-down control.”
He added that any service reconfigurations would continue be subject to four tests: They must be supported by GP commissioners; strengthen public and patient engagement; be underpinned by clear clinical evidence; and the reconfiguration must not limit patient choice.