Top doc­tors warn of hos­pi­tal clo­sures in NHS shake-up

Con­sul­tants warn that job losses and ser­vice cuts will hit pa­tient care

The Observer - - NEWS - By Denis Camp­bell Health Pol­icy Edi­tor

Al­most two in three se­nior doc­tors fear a con­tro­ver­sial NHS shake-up that will down­grade or close dozens of hos­pi­tal units will dam­age the care pa­tients re­ceive. The hos­pi­tal con­sul­tants fear the sus­tain­abil­ity and trans­for­ma­tion plans (STPs) will lead to staff los­ing their jobs, will ex­ac­er­bate work­force short­ages and will act as a cover for cuts to ser­vices.

Of 450 hos­pi­tal clin­i­cians sur­veyed by the Hos­pi­tal Con­sul­tants and Spe­cial­ists As­so­ci­a­tion (HCSA), 42% believe that STPs will have a “neg­a­tive im­pact” on pa­tient care. Barely one in 10 con­sul­tants who be­long to the union ex­pect a “pos­i­tive im­pact”.

Three in four (77%) fear STPs are a way of mak­ing cuts to the NHS, while just over half (56%) fear they will lead to job losses and worse un­der­staffing.

NHS Eng­land chief ex­ec­u­tive Si­mon Stevens views STPs as lo­cal plans that will mod­ernise the way pa­tients are cared for, re­duce the pres­sure hos­pi­tals are un­der, and help plug the £22bn gap in the ser­vice’s bud­get ex­pected to have opened up by 2020.

Pa­tients will be cared for more of­ten in or close to their homes to avoid un­nec­es­sary stays in hos­pi­tal. Stevens has di­vided Eng­land into 44 “foot­prints”, many of which are fac­ing big changes to how clin­i­cal ser­vices in the area are or­gan­ised, in­clud­ing the down­grad­ing or clo­sure of units.

But plans to cut the num­ber of hos­pi­tals, shrink the sup­ply of beds and cen­tralise key ser­vices have sparked protest cam­paigns in many parts of Eng­land. Theresa May re­layed her anx­i­ety about the po­lit­i­cal fall­out from a se­ries of A&E, stroke, ma­ter­nity and other units be­ing down­graded or closed when she met Stevens for the first time last Septem­ber.

Last week Rishi Su­nak, the Con­ser­va­tive MP for Rich­mond, and Dar­ling­ton’s Labour MP Jenny Chap­man put aside party al­le­giances to write to Stevens and voice their con­cerns about pos­si­ble bias in the STP process that has raised doubts about the fu­ture of ser­vices at Dar­ling­ton Me­mo­rial Hos­pi­tal, which could see its A&E and other departments taken away and trans­ferred to the North Tees Hos­pi­tal, 12 miles away in Stock­ton-on-Tees.

“Many hos­pi­tal doc­tors see STPs as a man­age­ri­ally driven process with no real clin­i­cal ba­sis, and fear that a mix of un­der­fund­ing, un­der-re­sourc­ing and ser­vice ra­tio­nal­i­sa­tion can only dam­age pa­tient care,” said Ed­die Sav­ille, the HCSA’s chief ex­ec­u­tive.

“This is, in ef­fect, yet again an NHS re­or­gan­i­sa­tion, but re­gion by re­gion, with man­age­ment try­ing to plug the fi­nan­cial gaps rather than putting high­qual­ity care of pa­tients at the fore­front. The fact that STPs are be­ing planned against a back­drop of un­der­fund­ing and cuts has led many doc­tors to con­clude that this trans­for­ma­tion pro­gramme is purely an at­tempt to mask fur­ther cut­backs.”

Al­though a ma­jor­ity of the HSCA mem­bers sur­veyed are un­de­cided on STPs, al­most all (95%) said they had not been in­volved in draw­ing up their lo­cal plan, prompt­ing Sav­ille to claim that they have been “shut out and sys­tem­at­i­cally ex­cluded” from the process.

The King’s Fund health think­tank

‘This is yet again an NHS re­or­gan­i­sa­tion, re­gion by re­gion, with man­agers try­ing to plug fi­nan­cial gaps’ Ed­die Sav­ille, doc­tors’ leader

says STPs “of­fer the best hope of de­liv­er­ing es­sen­tial re­forms to NHS ser­vices”, that con­cen­trat­ing spe­cial­ist ser­vices will im­prove pa­tient care, but that the NHS needs more money to en­sure suc­cess. The Bri­tish Med­i­cal As­so­ci­a­tion, mean­while, has dubbed STPs “a cover to de­liver £26bn in cuts to health and so­cial care [in which] mil­lions of pa­tients will be af­fected by hos­pi­tal and bed clo­sures”.

The Lo­cal Gov­ern­ment As­so­ci­a­tion, which rep­re­sents lo­cal coun­cils, crit­i­cised STPs as “se­cre­tive, opaque and top- down” re­forms that would fail pa­tients.

Cam­paign­ers in Hud­der­s­field against the clo­sure of its hos­pi­tal’s A&E unit de­cided last week to seek a ju­di­cial re­view of the law­ful­ness of the plan, drawn up by the lo­cal NHS clin­i­cal com­mis­sion­ing group. They fear lives could be lost if peo­ple from the town are forced to travel the 15 miles to Hal­i­fax for ur­gent and emer­gency care. The plan has been re­ferred to the In­de­pen­dent Re­con­fig­u­ra­tion Panel, an ex­pert group that ad­vises Jeremy Hunt, the health sec­re­tary, on which hos­pi­tal units should be al­lowed to close.

Rosie Duffield’s vig­or­ous de­fence of the hos­pi­tal in Can­ter­bury played a key role in her be­ing re­turned as the Kent town’s first ever Labour MP at the gen­eral elec­tion in June, oust­ing the Tory in­cum­bent, Sir Ju­lian Bra­zier, in the process. Fears raised by the NHS de­cid­ing that pa­tients from the Can­ter­bury area need­ing ur­gent treat­ment for a heart at­tack, stroke or pneu­mo­nia should in­stead go to Ash­ford or Mar­gate led to claims that peo­ple would die be­cause of the change.

Hun­dreds of peo­ple protested last week­end in Louth, Lin­colnshire, against plans that could see the hos­pi­tal close or be down­graded through a merger with Skeg­ness hos­pi­tal. How­ever, Louth’s Tory MP, Vic­to­ria Atkins, has ac­cused cam­paign­ers of “scare­mon­ger­ing” over the hos­pi­tal’s fu­ture.

Rex

Pro­test­ers in Hud­der­s­field march in an at­tempt to save their ca­su­alty unit.

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