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Prominent in the Yorkshire local news this week is coverage of the proposed closure of Leeds NHS trust’s children’s heart surgery unit. Nationally the number of children’s heart centres will be reduced from 11 to 6 or 7, with the unit at the LGI being one of those under threat. Naturally there is considerable local opposition, but the story is not unique to Yorkshire and similar stories will be unfolding in many communities across the country. The maternity unit at Pennine Trust’s Rochdale infirmary will be closing later this year and next week Lansley will make a decision about the long running argument about the closure of A&E at Barnet and Chase Farm. As Chris Ham of the Kings Fund points out “Chase Farm is a test case for the rest of the NHS. Unless ministers are willing to grasp the nettle and recognise the need urgently to undertake significant reconfigurations of hospital services across the country, then the NHS’ ability to achieve the big NHS efficiency savings its needs whilst delivering safe services will be in jeopardy”.
Centralising A&E, maternity and specialist services on a regional basis will be key to the NHS’ survival, the standard model of the mid sized DHG delivering all healthcare services is just not sustainable. If a hospital provides a specialist service which is ultimately underutilised, when there is a high cost of attracting the right specialist consultants and investing in the right technology and supporting infrastructure, then the unit cost of service delivery will quickly exceed a break even point. And small hospitals that lack economies of scale will have an even tougher challenge and will be susceptible to acquisition. Unfortunately the notion of free healthcare delivery at the point of use is one that is engrained in British culture, and most of the British public expect all of their healthcare services to be available locally from their local hospital. This coalition government will be remembered for hospital and service closures, and expect them to rapidly lose support in the areas worst affected. However the sustainability of the NHS could well be dependent on such tough decision being taken. Will the government grasp the nettle as Chris Ham suggests, or will the force of local politics be too strong to allow the much needed reconfigurations to go through? As ever I’d be interested to hear your thoughts.
Steve Melber, is Senior Consultant, Health at Interim Partners.
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