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21 November 2016

United Kingdom: A&E, Cancer and Maternity Units to Close in Major NHS Overhaul

Prof Sir Bruce Keogh argues that centralising some types 
of medical care benefits patients.  
Photo:  Christopher Furlong/Getty Images
A&E, cancer and maternity units to close in major NHS overhaul
The Guardian,18 November 2016

As detailed healthcare strategy plans emerge and opposition grows, local hospitals face the loss of thousands of beds

Thousands of hospital beds are set to disappear, pregnant women will face long trips to give birth and a string of A&E units will be downgraded or even closed altogether as part of controversial NHS plans to reorganise healthcare in England.

A Guardian analysis of the 24 NHS regional plans that have now been published – more than half the total of 44 – has found that health service chiefs plan to push through an unprecedented centralisation of key hospital services across England.

Opposition to the plans is growing among campaign groups, councillors and a growing number of MPs, including Conservatives, in areas where major changes are planned amid fears that patients will be unable to access urgent care quickly enough.

Dozens of England’s 163 acute hospitals look likely to have services, including cancer, trauma and stroke care, removed as a result of the plans, which are at the heart of the new funding package for the NHS. The thinking behind the changes is that some NHS services can be rationalised and managed more efficiently, helping improve patient care, tackling understaffing and helping the NHS save £22bn by 2020 as part of the wider financial settlement agreed for the current parliament.

Prof Sir Bruce Keogh, the NHS’s medical director, and clinical leaders involved in drawing up the plans argue that centralising some types of medical care benefits patients and improves their chances of a good outcome because doctors deal with more cases of certain ailments.

Many of the plans make clear that widespread staff shortages are another key driver. They hope that by concentrating sometimes scarce medical personnel in fewer places they can ensure consultant presence more often than otherwise and so help realise Hunt’s ambition of a more 24/7 NHS.

However, local resistance is building up as details emerge. Campaigners in Cumbria, for example, are warning that patients will die, including mothers and babies, if they have to travel 40 miles from Whitehaven to Carlisle for care – a journey that can take up to two hours depending on the time of day, weather and traffic levels, they say.

“Centralisation of services won’t work in Cumbria,” said Annette Robson, a campaigner from the We Need West Cumberland Hospital Group. The hospital’s A&E unit is set to be downgraded, with more serious urgent and emergency cases having to go to Carlisle for treatment.

“We are not asking for specialist services. We are asking for basic provision of a 24/7 A&E and a consultant-led maternity unit in Whitehaven,” she said. “If they go, there is no doubt that lives, including those of mothers and babies, will be lost on the 40-plus mile journey to Carlisle from Whitehaven.”

Many of the published plans give few details of their exact implications. But those that do make clear that several thousand beds in acute district general hospitals are likely to be cut. They include 535 in Derbyshire and 400 each in Devon and West Yorkshire and 30% of all beds in hospitals in Bristol, North Somerset and South Gloucestershire.

South-west London will also see its bed capacity shrink considerably when one of St George’s (1,038 beds), Kingston (520 beds), Croydon (443 beds), Epsom (374 beds) or St Helier (525 beds) hospitals lose all their acute services, because the plans for that area say that five acute hospitals cannot be sustained.

The plans are the vehicles for implementing locally the NHS Five Year Forward View, NHS England chief executive Simon Stevens’s blueprint for transforming services to cope with the growing demand for care while also delivering the £22bn of savings he has pledged to find by 2020.

Jeremy Hunt, the health secretary, has backed them, but stressed that potentially unpopular decisions will be taken by local NHS and council leaders, and not by ministers. Theresa May is said to have recently told Stevens to ensure that hospital closure plans did not become a big issue in newspapers.

Conservative MP Dr Daniel Poulter, who was a health minister until May 2015, said he feared the real potential of the plans to improve the quality of care could be lost because the need to make savings will become a top priority.


Mounting protests could coalesce into a political challenge for the government, he added. “Given that the NHS is often seen through the prism of hospital services changes and closures in marginal seats, the political consequences of how the plans are being forced to operate will soon be all too apparent,” Poulter said.

The exact number of bed losses will increase substantially as a result of plans in most of the 44 areas to provide a wide range of specialist medical services at many fewer sites than at present. The areas involved include parts of Somerset, Cheshire and Merseyside, Bedford, Luton and Milton Keynes. None of the 24 plans spells out who will be the winners and losers from the reorganisation.

Several hospitals face being “gutted” of key services, say critics. For example, Bedford hospital will lose its A&E and consultant-led maternity units and the ability to undertake most emergency surgery.

Similarly, plans to change utterly the role of Barnstaple hospital in Devon have already prompted a 4,000-strong protest march. Chester MP Chris Matheson has started a campaign to stop the closure of the city’s Countess of Chester hospital, which is at risk because of a mooted merger with two others.

Many hundreds of beds in community hospitals are also set to go, despite the key role they play in rehabilitating mainly elderly patients – for example, those who have had surgery or a fall. Devon plans to close four community hospitals altogether, as does Dorset (three) and Leicester, Leicestershire and Rutland (two).

All the proposals in the plans will be put out to public consultation, so may be changed as a result of opposition. But Stevens and other senior NHS bosses have made clear that a radical transformation in how the NHS functions is needed.

NHS England says that a huge increase in care outside hospitals, including in partients’ homes, and much greater efforts to keep people healthier for longer, will reduce the need for beds in hospital.

A&E units at hospitals in Macclesfield, Milton Keynes, Teesside and Hinchingbrooke in Cambridgeshire are all likely to be downgraded.

Maternity care at the Horton hospital in Banbury, Oxfordshire, is likely to be supervised in future only by midwives, not doctors. Centralisation of childbirth units is also set to lead to downgrading at Yeovil hospital in Somerset, and also at as yet unidentified hospitals in Surrey, Birmingham and Solihull and Leicester, Leicestershire and Rutland, among others.

“Despite the flannel and platitudes these STPs are NHS England’s way of forcing local health bosses to make cuts, since genuine savings on this scale cannot be delivered,” said Dr John Lister, a health policy expert and co-ordinator of the Health Campaigns Together group.

But Prof Chris Ham, chief executive of the King’s Fund, said STP-driven downgrades of certain services were in effect painful medicine that the NHS had to take to ensure it survives.

“The public may be understandably concerned about travelling further to access A&E care. But in many cases that will be a price worth paying for a higher standard of care, and the same would apply to maternity services. Overall this is a painful process that the NHS has to go through,” added Ham.

An NHS England spokesman defended the plans as necessary modernisation. “Our NHS has constantly adapted to improve services for patients, taking advantage of new opportunities and making commonsense changes in areas that really matter to patients – making it easier to see a GP, providing more specialist services in people’s homes, speeding up cancer diagnosis and offering help faster to people with mental illness.

“We are talking about steady incremental improvement, not a big bang, tackling things doctors and nurses have been telling us for years. By continuing to adapt to a changing world, the NHS will be able to secure a better service for future generations”.

https://www.theguardian.com/society/2016/nov/18/ae-cancer-and-maternity-units-to-close-in-major-nhs-overhaul

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