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Wave of NHS closures

19th September 2006

10052006_consultant1.jpgDavid Nicholson, chief executive of the NHS, said in an interview with the Guardian that the NHS is preparing a wave of closures of key hospital departments across England in the run-up to the next general election.

He said there would be up to 60 "reconfigurations" of NHS services, affecting every strategic health authority. Most changes will be aimed at redesigning the NHS to improve care by concentrating key services in fewer hospitals, but some changes will address the overcapacity that contributed to the NHS's large deficit in the last financial year.

Mr Nicholson indicated that A&E departments, paediatrics and maternity services would be looked at in particular. He said that "Undoubtedly there will be tough decisions to make over the next 12 months to reflect changing services", adding that it was about delivering care which is predominantly closer to home.

Plans to downgrade key services at district general hospitals would be likely to provoke intense opposition, but Mr Nicholson was optimistic that the public would back his plans if they understood the advantages of reform to patients.

Mr Nicholson said that 'each SHA will have about half a dozen reconfigurations', including plans for patients suffering major injuries to be taken to a specialist trauma centre; patients requiring minor emergency treatment will be encouraged to go to walk-in clinics. The plans will call into question the viability of running a full A&E department in every district general hospital.

The NHS also had to tackle the "wicked issue" of maternity services, said Mr Nicholson. He added that pregnant women would be best served by maternity departments big enough to sustain a 24-hour, consultant-led service.

Some treatments would move out of hospital into community clinics and GP surgeries, with some hi-tech services to be concentrated in specialist centres.

He said the NHS was unlikely to deliver the pledge that all acute hospital trusts should be ready to apply for foundation status by 2008, and that 'one answer might be for strong trusts to take over the weak.'

Dame Karlene Davis, General Secretary of the Royal College of Midwives, said that she was "dismayed and appalled that David Nicholson's prejudiced views are displayed in national newspapers as if he knows what is best for pregnant women".  She added that there was no evidence to support his view that consultant led units are best. She maintained that Mr Nicholson is overturning the manifesto pledge on which this Government was elected; that by 2009 all women will have choice over where and how they have their baby and what pain relief to use.

Mr James Johnson, chairman of the British Medical Association (BMA), said that the BMA, contrary to some media reportage, had not signed up to Government plans to close up to 60 hospital departments across England.

The BMA acknowledged that it is becoming more difficult for smaller hospitals to provide a comparable range of comprehensive services, and that it made sense to review the range of services available in each hospital serving particular geographical areas. However, Mr Johnson said that closing an A&E department will lead to other services being taken away, eventually leading to a complete hospital closure, adding that this must not be allowed to happen.

"Reconfiguration to suit political needs or decisions based solely on cost would be completely unacceptable" Mr Johnson said.

The Royal College of Physicians (RCP) likewise said it had not given its support to any government plans to close hospitals in England. The RCP acknowledged that in future the existing number of acute hospitals with all-risk 24-hour emergency cover would not be able to be maintained. However, it said the closure must be carried out in consultation with local health professionals and the public, and only if it meets the high standards of care expected.

Nigel Edwards, director of policy at the NHS Confederation, said: “We need to get away from the fixation with buildings. We should recognise that services can be delivered in many settings and that proximity to a hospital may be less important than the ability to access the right services for a patient’s needs."

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Comments

Pat Roberts

Friday 29th September 2006 @ 14:37

It would be helpful to the public if a graphical holistic picture of planned services could be displayed. Planning in a disparate manner without the whole picture can only lead to frustrations, errors and waste of time and effort.
This picture could indicate patient flows, journey length, quality of services available etc.


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