Today, The Big Question (BBC1) discussed the phasing out of local hospitals. Professor Terence Stephenson, who was introduced as the new chair of the Academy of Medical Royal Colleges, insisted that they should be replaced by large medical centres of specialised excellence.
Julia Manning, who was merely named – with no reference made to her role in 2020 Healthcare – eloquently supported his proposal.
Dr Clive Peedell, who had to introduce himself as a cancer specialist and co-founder of the National Health Action Party, expressed the belief that there should be centres of excellence but also a network of local hospitals.
He pointed to the findings of the Organisation for Economic Co-operation and Development: the number of UK hospitals per 1000 of the population is already extremely low:
Dr Peedell added that many hospital beds had already been cut and that currently there is 90% occupancy – though the safe level is 85%.
Closures of hospitals or just A & E and/or maternity departments mean that emergency cases travel further and are treated later.
A & Es are being closed in many areas, or downgraded as Urgent Care Centres opening only12 hours a day. This happened at Chase Farm in Enfield, leaving what Nick de Bois, Conservative MP for Enfield North, described as a ‘confusing mish-mash’ of emergency services at the site. A child died there after his mother found the UCC closed.
She wondered if undertakings given could be trusted; the local Peterborough City Hospital had been funded by PFI, which – at the time -residents were assured was a sound decision. Now it is costing £40m a year, has 31 years left to run and the arrangement can only be ended by making a very substantial one-off payment.
She also reminded those present that similar undertakings were made about mental health care when hospitals were closed; adequate care in the community ‘didn’t happen’.
If local hospitals close, Ms Manning said that GPs and district nurses would give medical care in the community. However district nurses’ numbers are down and very few are being trained. The BBC reported that official figures show that the number of district nurses has fallen by 40% in the past decade; ten years ago there were nearly 13,000 NHS district nurses in England but last year there were fewer than 7,500 and many of those are approaching retirement age.
The consultation process was briefly touched on
Nicky Campbell wondered if fast track consultation would be ‘circumventing democracy’. A search revealed that clause 118 of the Care Bill, which is currently going through Parliament, gives Clinical commissioning groups (Cogs) just 40 days to consult on changes proposed by an administrator. Their views could be overruled by NHS England, so local decision makers would have no real power over proposed changes to their hospital services.
Dr Peedell said that the changes were not being made for clinical reasons, but were financially driven – the market in healthcare actually drives up costs and there would be an increase in private medicine and health insurance.
Both doctors agreed that there was clear evidence that large specialist centres offered a better outcome for some conditions – for instance heart attacks. But Dr Peedell insisted on the need for local hospitals for many other conditions, such as asthma, where a longer journey time could be dangerous.
Monitor, the health sector regulator, reports that by 2021 the NHS will face a £30bn funding gap. Dr Peedell and a member of the audience offered solutions: hospitals are more worthy of the money readily made available to bail out banks, HMRC should also address both tax avoidance and tax evasion.
Other areas might benefit from the example of the Tees, Ask and Wear Valleys trust which paid £18m to get out of the PFI contract 23 years early, but it now owns the hospital outright and expects to save £14m over the course of the deal – once maintenance and inflation is taken into account.
The writer would like to see the taxpayers’ money already being spent on preparation for High Speed Rail 2 and the huge sum for its implementation, used to help debt-ridden hospitals.
The doctors could agree but the healthcare industry stands to lose a great deal if they do
Julia Manning of 2020 Heathcare spoke eloquently in favour of this reform. Her company’s sponsors, who include Baxter Healthcare, Bosch Healthcare, Lundbeck & Pfizer Pharmaceuticals, Denplan, Gilead biopharmaceuticals, Tunstall Healthcare, Abbvie Pharmaceuticals, MSD (Merck) Pharmaceuticals, Abbott Laboratories, will agree that she is most persuasive.
But vested interest must not determine the future of Britain’s health service.