Closing down hospitals ‘could be essential for stricken NHS’
●Medics call for ‘courageous decisions’ to make best use of scare resources
Senior medical leaders in Scotland have warned that hospitals and services may have to go if the NHS is to make the best use of scarce resources.
The closure of redundant facilities may be “essential” if the NHS is to prioritise the “right and most valuable approach” to patient care, according to the the Royal College of Physicians of Edinburgh (RCPE).
It is calling for “courageous decisions” from political leaders in the face of “misleading” demands for “more doctors, more nurses” in face of tightening budgets.
Health Secretary Shona Robison is currently considering a proposals to close Lightburn Hospital in Glasgow, while other services around the country could disappear as part of a shift towards regional “centres of excellence”.
These are often seen as the best way to maintain standards of patient care in areas such as orthopaedics, maternity and paediatrics, as growing population demands increases the strain on services.
The RCPE warns Scotland is not making the best use of NHS facilities in a submission to Holyrood’s health committee. “With limited national wealth, decision-makers and influencers must realise that the removal of redundant, although cherished facilities, practices and remedies is essential,” its states.
“There is ample evidence about the right, and most valuable, interventions to prioritise. This involves choice, and taking a population approach in proportion to needs. The media’s focus on exceptions and deficits, and the most vocal advocacy, must have a counter-weight in evidence informed decision-making, taking judgement on comparative value.”
There are even fears that decisions to keep hospitals open are not being taken for the best clinical reasons but to avoid a backlash.
“There is the background of media, public and political expectation that the care services will cope whatever the inputs – ‘more doctors, more nurses, more ambulances and helicopters’.” the submission adds.
“This is persistently misleading, and leads to inappropriate investment decisions and failure to take courageous decisions to set and stick with priorities.”
Ms Robison is considering plans
to close Lightburn Hospital in the east end of Glasgow which have would affect up to 700 patients as part of a £70 million cost-cutting drive by NHS Great Glasgow and Clyde. A previous plan to close the hospital was rejected by ministers.
It also proposes to move paediatric services from the Royal Alexandra in Paisley to the new Children’s Hospital at the Queen Elizabeth in Glasgow. Maternity services at the Vale of Leven in Dunbartonshire are also facing the axe
In Highland, the board of NHS Highland has approved a plan to set up maternity services at Caithness General in Wick as a Community Midwife Unit (CMU), with women at risk of birthing complications taken to Raigmore Hospital in Inverness, about 102 miles away.
Cleft lip and palate surgical services have been axed at the Royal Hospital for Sick Children in Edinburgh, with patients instead moved to Glasgow for surgery. In Edinburgh, Liberton hospital is to close next year after a further loss of beds recently.
A new national strategy for the NHS published by the Scottish Government last year warned that ongoing auster- ity cuts mean there will be “constraints on what can be achieved with anticipated future resources.”
It points to growing evidence that many less complex operations are best carried out in “specialist” units.
It adds: “This strategy sets out the evidence that some services should be planned at a national, regional or local level on a population rather than geographical boundary basis. This would mean that, for some services, there would be fewer specialist inpatient units within a region.”
A Scottish Government spokeswoman said: “People are now living longer lives, which means our health and care services must change to aid increasingly more people living with multiple, complex conditions. Our ambitions for the NHS are founded on the twin approach of investment and reform.”
Ministers say that NHS revenue spending will increase by £2 billion by 2021.
Labour health spokesperson Anas Sarwar said: “A decade of SNP mismanagement has left our NHS staff overworked, undervalued, underresourced and underpaid.
“We have severe shortages of NHS staff.”
The closure of a public service facility is almost always a matter of controversy and regret, particularly if the cause of loss is a lack of sufficient resource to maintain viability.
Experience shows us that when a facility goes, it is unlikely to return any time soon. Take, for example, the railway lines and stations which were removed from the network in the 1960s and 1970s, many of which remain sorely missed. It is far easier to close than to re-open.
In that knowledge, the Royal College of Physicians of Edinburgh (RCPE) is unlikely to have come easily to the conclusion that, if the health service is to make the best use of limited resources, it may be prudent to close some hospitals and centralise services.
For those who use these facilities and services, such a suggestion can be alarming. No-one wants to have to travel further for treatment than they already do, and no-one wants to lose a community facility which has been relied on for generations.
But it makes sense to consolidate services, both in terms of available resources and modern-day requirements. A cottage hospital which was most effective in its community several decades ago can look more like an anomaly in 2017. As the RCPE has noted, there are concerns that some facilities have been kept open not to provide effective care, but to prevent the backlash that closure would cause.
We have seen recent evidence in Scotland of the strategy suggested by the RCPE, with a move towards specialist centres, and we can expect to see further re-allocation of resources based on population counts rather than geographical spread.
This will give rise to concerns from rural communities, where accessing a centralised service could involve a lengthy journey. There have already been protests over the downgrading of maternity services at Caithness General in Wick, with women at risk of birth complications now having to travel 100 miles to Inverness.
It is in these such areas where exceptions will have to be considered, if the strategy is to work. The more distant a service, the greater becomes both the inconvenience and the risk.
Consolidation is taking place in many industries at the moment, but if this strategy is to succeed with health services, in certain areas it will require to be done with more than just the balance sheet and size of population in mind.