NHS chief: stop playing politics with closures
http://www.guardian.co.uk/society/2013/jan/24/nhs-politics-closures Version 0 of 1. Politicians should put aside their local and electoral interests and stop fighting hospital closures, according to the medical director of the NHS. Sir Bruce Keogh, the former heart surgeon who now leads on standards and performance in the health service, told the Guardian that failing to embrace change, including closures, would inhibit excellence and "perpetuate mediocrity". He said: "I really need the help of our political colleagues at times to step above their local interests and think of the other interests of the NHS." People should understand that change involved closing some services and taking patients to specialist centres where standards were higher, Keogh said. But local politicians, and sometimes doctors, were fighting hard for units to stay open. "Unless we can get to that place where people look at the greater good, which is sometimes in conflict with local interests, then professional, personal and political interests will conspire to perpetuate mediocrity and inhibit the pursuit of excellence to the detriment of our NHS and ultimately our patients," he said. Recent interventions by politicians over hospitals used by their constituents include foreign secretary William Hague's opposition to plans to downgrade maternity and children's services and justice secretary Chris Grayling's and work and pensions secretary Iain Duncan Smith's protests about threats to A&E units. NHS bodies in at least 15 parts of England are pursuing major reconfiguration plans, many of which are being opposed by MPs from all the main parties. Keogh's views are shared by Lord Darzi, the eminent heart surgeon who spent two years as a health minister under Labour redesigning NHS services. He led the successful change to stroke and cardiac care in London.Darzi speaks of "the politics of saving lives versus the politics of saving votes" and says he would like to see more clinicians on platforms, making the case for restructuring. "Anyone who doesn't embrace change in a position of power, whether clinician or politician, should be held accountable for the consequences of the NHS failing to deliver the quality of care expected," he said. Senior doctors and NHS leaders today warn in a letter to the Guardian that ministers and the NHS "must grasp this nettle" and replace much hospital care with new services in or nearer to patients' homes – otherwise the service will be unsustainable, some hospitals could fail and the quality of care will fall. The signatories include the leaders of the UK's 200,000 doctors as well as organisations representing surgeons, GPs, specialist child doctors and 90% of England's hospitals, and also 130 health and social care charities. "Changes of this kind are often highly controversial locally with the result that they can be stalled or ducked, sometimes for years. In the current climate, such fudging will make matters worse. It will risk increasing numbers of NHS organisations becoming unsustainable, while quality suffers," say the signatories, who include Professor Terence Stephenson, chair of the Academy of Medical Royal Colleges, and Mike Farrar, chief executive of the NHS Confederation. They back greater centralisation of hospital services and warn patients to be ready to travel longer distances to receive the best care, depending on their condition. But at the same time "people's concerns about safety and access to services, including transport issues [must be] properly resolved", they add. Keogh acknowledges it is vital that new services are in place before existing ones are closed – for instance, urgent care centres must be available locally to deal with minor injury and illness, with the capacity to transfer patients who need it to a specialised A&E some distance away. "The bit that worries me is a family who don't have much money, who are struggling and may have a couple of kids – the idea of some poor mum having to travel to A&E on two buses because we closed an A&E down and she doesn't have confidence that what is left is good enough," said Keogh. "I don't think we can change the system until we know we have a solution that is OK. The NHS is here for the most vulnerable members of society. We have to have a system that protects people who don't have money and are struggling. I hear people saying it is only three miles down the road. Three miles down the road is pretty difficult for some," he added. Last week the NHS chief executive, Sir David Nicholson, pledged that the new NHS Commissioning Board, which will start running the service in April, would use its £95bn budget to push through major changes. "You will see fewer units doing more things," said Nicholson, who wants to see more "clustering" of services at certain hospitals. "It's hard to imagine a service change that's going to take place in the next few years that the commissioning board is not directly involved in", added Nicholson. In particular the board plans to use its £12bn specialist medical services budget to compel some hospitals to stop treating certain conditions. Keogh is to lead a review of urgent and emergency services across the NHS. Nicholson has also told NHS bosses that they need to draw up plans to reorganise services as soon as possible because, while ministers will back proposals that are justified clinically during the course of this year, they will not do so closer to the 2015 general election. NHS leaders have a "narrow window" to get changes planned, publicised and supported before political support fades, he believes. Most of the opposition to reconfiguration is from people who are angry about local closures and changes, but John Lister of London Health Emergency offered a broader view. "There will be fewer centres, but what capacity are those centres going to have?" he asks. He argued that they would be overwhelmed by all the patients being sent to them from a distance and that the local services that are supposed to reassure people and treat easy or non-urgent cases did not yet exist. "Every part of London is now facing some kind of rationalisation. If they all do it at once, where are people supposed to go? It is a completely hypothetical series of promises out there. People are being asked to buy things on trust, but there is nothing to repay that trust." When trauma, as well as stroke and cardiac care, was concentrated in fewer hospitals, "our gut instinct was to be suspicious", Lister said, but now "I have no argument with that". However, trauma is a tiny proportion of A&E and reducing the number of hospitals that can deal with the majority of cases is dangerous, he believes. |