My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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Post May 6th, what’s going to happen to England’s hospitals?

Filed Under (Health Policy, National Voices, Reform of the NHS) by Paul on 29-04-2010

On March 26th the patient’s collective organisation National Voices wrote an innovative and important letter to the Times in which they called for a grown up debate about closing beds in hospitals. Whilst on the inside of the NHS we have known the maturity of these organsiations for some time, to publish these collective opinions just before an election campaign was an important step forward.

Here is the letter:

Sir,

Various experts are calling for hospital closures and a shift of NHS funding into primary and community settings. It is time for patients and carers to have a say. National Voices is a coalition of national voluntary organisations advocating for patients, carers and service users. Our members expect a wave of service changes including hospital closures as the NHS scrabbles to find some £20 billion of savings.

This need not be a bad thing. Too many people are admitted to hospital unnecessarily, stay too long and have a poor experience. Better care planning for the 17 million people with long-term conditions would keep more people out of hospital, in better health and at less cost to the taxpayer. Not all hospital care is good enough, safe enough, or in the right place.

It does not follow that every hospital closure will be justified. Cutting costs risks cutting corners. It’s our NHS: local citizens must have a genuine say in local schemes. In much of the country this does not happen. Too often people experience a tick-box “consultation” on what is really a fait accompli.

We demand a different approach, which treats people as grown-ups. Managers must do their homework and present schemes that will improve quality and safety. People must be informed and involved from the outset, and shape the outcome. They must have a say in the new services that replace the old. They need sufficient reassurance on matters of concern.

Above all, local leadership is required. If there is a medical case for change, let’s hear the doctors making it. And local politicians need to be responsible. “Save our local hospital” is the line of least resistance and not always the right one.

Jeremy Taylor
Chief Executive, National Voices

Jeremy Hughes
Chief Executive, Breakthrough Breast Cancer

Douglas Smallwood
Chief Executive, Diabetes UK

Belinda Phipps, Chief Executive, National Childbirth Trust

Betty McBride
Policy & Communications Director, British Heart Foundation

Alex Fox
Director of Policy and Communications, Princess Royal Trust for Carers

Neil Churchill
Chief Executive, Asthma UK

On April 28th the leaders of most of the Medical Royal Colleges wrote to the Guardian with a similar message.

This is the most closely contested general election for more than a decade and health is one of the top priorities for voters and politicians. While we welcome the focus on the NHS, we are concerned that the political debate and its attendant media coverage tend to overlook the cogent arguments for service change that will bring long-term benefits for patients.

There has been a wealth of clinical evidence for many years that specialist clinical services, such as stroke, trauma and heart surgery, should be concentrated in fewer centres. This would allow the latest equipment to be sited with a critical mass of expert clinicians who regularly manage these challenging clinical problems, and are backed by the most up-to-date research. The greater volumes of patients mean doctors are better at spotting problems and treating them quickly. Survival and recovery rates would improve markedly with many lives saved. As techniques and technology have developed over recent years, speciality rather than proximity has become the key for patient safety. So increased patient safety and improved care must be the major drivers of any reconfiguration.

Patients may indeed have to travel further for some specialist care, but if it is significantly better care then we believe that centralisation is justified. However, at the same time there is also strong evidence to support a large amount of more routine care, currently taking place in hospitals, being carried out closer to where patients live in the community with GPs playing a crucial role in the delivery of services.

Delivering this requires strong leadership and brave decision-making from doctors, managers and politicians. Simply condemning change as bad and defending the status quo as ideal is not serving the interests of patients.

If the NHS is to cope with the financial pressures it is going to face under any government without resorting to indiscriminate and damaging service and staffing cuts, large-scale planned service redesign and reconfiguration based on clinical evidence will have to be at the heart of the strategy. This may mean, for example, A&Es, children’s departments and surgical units at their local hospital either closing or providing a different type of service.

Such a process can significantly improve patient care. But if it is to be managed well and properly provide the highest quality care in the best clinical environment, it must directly involve doctors, other healthcare staff and the public. This involvement should include a voice in the planning and strategy development for such services, thereby ensuring appropriate service reconfiguration driven by clinical evidence and not simply the need for financial savings.

Professor Neil Douglas Academy of Medical Royal Colleges, Professor Ian Gilmore Royal College of Physicians, Professor Steve Field Royal College General Practitioners, Professor Hugo-Mascie-Taylor NHS Confederation, Professor Sabaratnam Arulkumaran Royal College of Obstetricians and Gynaecologists, Professor Terrence Stephenson Royal College of Paediatrics & Child Health, Professor Dinesh Bugrha Royal College of Psychiatrists, Dr Peter Nightingale Royal College of Anaesthetists, Dr Neil Dewhurst Royal College of Physicians Professor Andy Adam President, Royal College of Radiologists, John Lee Royal College of Ophthalmologists, Professor Alan Maryon Davis Faculty of Public Health Medicine, Dr Richard Tiner Faculty of Pharmaceutical Medicine, Professor David Coggon Faculty of Occupational Health

 

It is possible that these two letters will change the way in which NHS services develop much more considerably than who wins the election on May 6th. Both call for early public involvement in charge and both say that holding hospital service still is both unsafe and costly.

If we have a Secretary of State that wants to hold the status quo in hospitals for political reasons there will be some interesting battles ahead.

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