5 Jun 2013

NHS ‘reconfiguration’: not as scary as patients think

Medical colleges, patient groups and NHS organisations have today issued a warning that unless the NHS faces up to the need to change how it delivers its services, it will descend into a “vicious spiral” of poorly planned, reactive responses resulting in unsustainable demand.

What they are talking about when they use the word change is reconfiguration.  Looking at services and asking whether they could best be delivered in a different way.

And this is a subject that provokes the most incredibly emotive responses.  If there is one thing people love, it is their local hospital.  It doesn’t seem to matter that the accident and emergency unit might be so bad that ambulances prefer to take patients elsewhere, or that there are not enough consultants in the maternity unit to provide a safe service.

It is about proximity and familiarity and the suspicion that to close the A&E or the maternity unit or move stroke services is for the betterment of the doctors and the NHS and not for the patient.

Indeed, today the NHS Confederation, National Voices and the Academy of Medical Royal Colleges said there was a need to stop reconfiguration being seen as a dirty word, that there needed to be a more meaningful debate on how change was achieved.

There was also a call from Mike Farrar, the chief executive of the NHS Confederation, for more political courage or less political resistance.  It is certainly true that it is a rare MP who will stand up to their constituents and say that losing services or closing hospitals is actually for the good of the community.

They call it the fear of being Kidderminstered, after the 2001 election in which Dr Richard Taylor won the seat from Labour on the single issue of the return of A&E services to Kidderminster Hospital.

Currently there are about 20 planned or proposed reconfigurations across England, almost all being opposed locally.  The north west London reconfiguration proposal, for instance, which would see the closure of A&Es at Charing Cross, Hammersmith, Ealing and Central Middlesex, has led to marches, petitions and legal action.

Yet Ealing Hospital has regularly failed its four-hour wait and ambulances regularly divert the worst emergency cases to other hospitals.  So why the passion?  It is complex, as I know from chairing two public debates on this particular reconfiguration last year.

It was about localism – loving your local hospital – and about travel.  But also about capacity and the ability to soak up the extra patients.  There were some good points made about how far people would have to travel across a large borough to reach the nearest A&E or to visit friends and family.

On the other side were equally good points made about centralising specialist services, which has been shown to be safer, and increasing capacity in the remaining A&Es.  But it was clear in these debates that those opposing reconfiguration were not convinced and I am not surprised.  Those speaking for change did not argue their case particularly well and at times seemed either exasperated or even patronising.

I know they did not mean to come across that way but years of reporting the NHS has shown me that often those working in the health service do not know how to speak plain English and regularly fall back on jargon as well as making assumptions that people and patients know as much as they do about complicated statistical models of health care.  Anyway, it is easier to say “save my hospital” than it is to say “reconfiguration is the way to go”.

And that was Mike Farrar’s other message today.  Learn to explain the case for change so people understand what on earth you are talking about.

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