In the wake of the Francis report and Mid-Staffordshire scandals, it has recently come to light that a further 14 trusts are under investigation due to unnecessary deaths and appalling mismanagement. There may be more.
It is clear that our current system of healthcare regulation has failed. More importantly, this has meant that the NHS failed its patients. There have obviously been failures of hospital management as well as clinical poor performance. It is also the case that the physical structures of the NHS have long needed reconfiguration. It is about time we had a national plan to do it.
Governments of all colours have been avoiding the key decisions influencing the long-term future for our healthcare system for too long. Politicians have been defending local hospitals irrespective of their healthcare outcomes, just to secure ‘popular’ support.
To me, it is clear that this cannot continue. I cannot stress enough how important it is to ‘de-politicise’ the process, to prevent short-sighted approaches by local politicians to gain political capital.
At the same time, better communication with the public about the benefits and the drivers of better healthcare outcomes is of vital importance if dreadful events, such as those seen at Mid Staffs, are to be assigned to the past.
For sure, we cannot continue to rule on a ‘day-to-day’ basis, while behaving in such a risk-averse fashion. We need to be more honest about how we will be dealing with healthcare challenges of the future.
Growing demand through changing demographics such as increasing population, rising levels of obesity and an ageing society are all driving healthcare costs up inexorably. These challenges will need to be properly addressed and strategic cost savings made. No longer can we carry on prioritising targets and management processes above that of patients’ healthcare needs.
In particular, I have long argued for a genuine rethink of our current healthcare landscape. The reconfiguration of acute and emergency hospital services onto fewer sites is long overdue.
Currently, there is no clear direction for our hospital trusts. Hence I believe that there is an urgent need for greater leadership in this area from the Department of Health.
We are already suffering from fragmented hospital sites, many of which are in the wrong locations. Too many hospitals are operating with dangerously low levels of staff, particularly at weekends and Bank Holidays. We need to ensure that we have the same standard of care seven days a week. For example, it is much safer to have a child operated on by a surgeon who conducts such procedures regularly than one who operates less frequently.
The Royal College of Paediatrics calculated a potential shortfall of 600 doctors in paediatric units leading to some unit closure due to risk of being deemed unsafe. Similarly, being in a centre where there are several specialists helps with knowledge sharing and therefore improves the quality of care.
The consolidation of acute and emergency hospital services clearly would lead to improved quality and patient safety. Quite simply, fewer acute hospitals would improve clinical outcomes.
This is why last year I called for a healthcare reconfiguration plan involving my constituency. It proposed merging existing sites in the region onto one location on a nearby motorway. Since then, I have held public meetings throughout the Thames Valley and have consequently spoken to many people. By explaining ideas clearly and listening to the public’s concerns, I have managed to gain support for my ‘hub and spoke’ strategic plan too. I strongly believe that such a consolidation of healthcare services into a single acute hospital (hub), with smaller hospitals (spokes) providing chronic care in the community must be the best and most sustainable model of care for the 21st century.
The neglect and humiliation seen at Mid-Staffordshire was beyond comprehension, but it remains to see if we have learnt any lessons for these appalling events. Part of the solution is to engage the public, the NHS and central Government in a serious debate about hospital provision. Patient safety and quality of care can be drastically improved with regional centralised specialist hospitals.
I fear that, despite the wealth of evidence and the strong case for change, it remains one of those difficult conversations involving politicians, the public, civil servants and the medical profession.
Selling that A&E closures often saves lives to the electorate is politically very difficult. However, it must be done with the clear aim of improving clinical outcomes for all. I’ve started doing this in my constituency. It’s about time all other parliamentary colleagues started doing the same.
Dr Phillip Lee is MP for Bracknell