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| NHS needs major changes to avoid disaster, say managers and charities | NHS needs major changes to avoid disaster, say managers and charities |
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| Hospital reorganisations and major changes to the health service in England are needed to rescue the NHS from sometimes disastrous failures and a vicious spiral of badly planned responses to financial pressures, according to a coalition of health and social care charities, clinicians and managers. | Hospital reorganisations and major changes to the health service in England are needed to rescue the NHS from sometimes disastrous failures and a vicious spiral of badly planned responses to financial pressures, according to a coalition of health and social care charities, clinicians and managers. |
| They claim the "complicated and cherished institution" risks becoming paralysed by resistance to change and call for courage from politicians, the public and staff in reconfiguring healthcare. | They claim the "complicated and cherished institution" risks becoming paralysed by resistance to change and call for courage from politicians, the public and staff in reconfiguring healthcare. |
| The plea from the NHS Confederation, representing the health service senior managers, the Academy of Royal Colleges and National Voices is the latest attempt to campaign for fewer but bigger specialist centres for acute care and a properly planned transfer of other services outside hospitals at a time when fear of change being forced only by local financial cuts provokes big popular and political opposition. | The plea from the NHS Confederation, representing the health service senior managers, the Academy of Royal Colleges and National Voices is the latest attempt to campaign for fewer but bigger specialist centres for acute care and a properly planned transfer of other services outside hospitals at a time when fear of change being forced only by local financial cuts provokes big popular and political opposition. |
| "The health service is constantly under pressure from rising demand and limited resources, and must keep evolving to adapt to patients' changing needs and innovation in treatments," says the organisation's report, Changing Care, Improving Quality. "We are concerned that the debate on change has become polarised and is excluding those looking to engage in a more meaningful way. | "The health service is constantly under pressure from rising demand and limited resources, and must keep evolving to adapt to patients' changing needs and innovation in treatments," says the organisation's report, Changing Care, Improving Quality. "We are concerned that the debate on change has become polarised and is excluding those looking to engage in a more meaningful way. |
| "Nobody understands the NHS better than its patients, clinicians and managers. Every day, they witness at first-hand the incredible achievements of a healthcare system that is recognised around the world. But they also observe that historical patterns of provision mean care is often not in the right place or at the right time to achieve the outcomes patients want, and there are sometimes disastrous failures to maintain standards." | "Nobody understands the NHS better than its patients, clinicians and managers. Every day, they witness at first-hand the incredible achievements of a healthcare system that is recognised around the world. But they also observe that historical patterns of provision mean care is often not in the right place or at the right time to achieve the outcomes patients want, and there are sometimes disastrous failures to maintain standards." |
| The public was "rightly suspicious" of closures and downgrades "that seem to be more to do with money than quality of care" because the NHS had failed to make its case for controversial changes, said Jeremy Taylor of National Voices. It needed to involve patients and communities in ways that would build trust to ensure any new pattern of services was better than the old. | The public was "rightly suspicious" of closures and downgrades "that seem to be more to do with money than quality of care" because the NHS had failed to make its case for controversial changes, said Jeremy Taylor of National Voices. It needed to involve patients and communities in ways that would build trust to ensure any new pattern of services was better than the old. |
| Mike Farrar, the chief executive of the NHS Confederation, said: "Political courage by itself is not enough to deliver the kind of change that the NHS needs at this point in its life; the service itself must overcome its paralysis in relation to change and it must bring the right people with it." Merely tweaking the system was not the answer, he said. | Mike Farrar, the chief executive of the NHS Confederation, said: "Political courage by itself is not enough to deliver the kind of change that the NHS needs at this point in its life; the service itself must overcome its paralysis in relation to change and it must bring the right people with it." Merely tweaking the system was not the answer, he said. |
| The report was published as Farrar, seen as a possible successor to Sir David Nicholson, head of NHS England, prepared to tell his own organisation's annual conference that the NHS's present problems were a "product of poor practice, or policy, and a lack of honesty about how the service operates and its financial context". | The report was published as Farrar, seen as a possible successor to Sir David Nicholson, head of NHS England, prepared to tell his own organisation's annual conference that the NHS's present problems were a "product of poor practice, or policy, and a lack of honesty about how the service operates and its financial context". |
| "Of all the fall-out from Mid Staffs, the massive opportunity of openness, transparency and engagement with patients and the public is the greatest," he says. | "Of all the fall-out from Mid Staffs, the massive opportunity of openness, transparency and engagement with patients and the public is the greatest," he says. |
| However, discussion of a postcode lottery in the health service would test the public's faith in the system's fairness. "Revealing the variability of the current service outcomes, quality and capability is not something that sits well in a system that prides itself on equity and fairness. Variation in life expectancy creates moral outrage but variation in the ability of the service to operate successfully on your hernia, hip or your child's heart is in a different league." | However, discussion of a postcode lottery in the health service would test the public's faith in the system's fairness. "Revealing the variability of the current service outcomes, quality and capability is not something that sits well in a system that prides itself on equity and fairness. Variation in life expectancy creates moral outrage but variation in the ability of the service to operate successfully on your hernia, hip or your child's heart is in a different league." |
| Farrar will say that parts of the NHS have been unable to work collectively – a reason "why urgent and emergency services are under so much pressure". His intervention comes as fresh warnings emerge that the winter coming is likely to intensify pressure on accident and emergency wards. | Farrar will say that parts of the NHS have been unable to work collectively – a reason "why urgent and emergency services are under so much pressure". His intervention comes as fresh warnings emerge that the winter coming is likely to intensify pressure on accident and emergency wards. |
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