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Royal colleges speak out in favour of service reconfiguration

By Mike Broad - 29th April 2010 1:42 pm

A group of leading medical organisations have sent a letter to The Guardian in support of service change. They fear the debate is being misrepresented in the media. Here is the letter in full:

This is the most closely contested general election for more than a decade and health is one of the top priorities for voters and politicians. While we welcome the focus on the NHS, we are concerned that the political debate and its attendant media coverage tend to overlook the cogent arguments for service change that will bring long-term benefits for patients.

There has been a wealth of clinical evidence for many years that specialist clinical services, such as stroke, trauma and heart surgery, should be concentrated in fewer centres. This would allow the latest equipment to be sited with a critical mass of expert clinicians who regularly manage these challenging clinical problems, and are backed by the most up-to-date research.

The greater volumes of patients mean doctors are better at spotting problems and treating them quickly. Survival and recovery rates would improve markedly with many lives saved. As techniques and technology have developed over recent years, speciality rather than proximity has become the key for patient safety. So increased patient safety and improved care must be the major drivers of any reconfiguration.

Patients may indeed have to travel further for some specialist care, but if it is significantly better care then we believe that centralisation is justified. However, at the same time there is also strong evidence to support a large amount of more routine care, currently taking place in hospitals, being carried out closer to where patients live in the community with GPsplaying a crucial role in the delivery of services.

Delivering this requires strong leadership and brave decision-making from doctors, managers and politicians. Simply condemning change as bad and defending the status quo as ideal is not serving the interests of patients.

If the NHS is to cope with the financial pressures it is going to face under any government without resorting to indiscriminate and damaging service and staffing cuts, large-scale planned service redesign and reconfiguration based on clinical evidence will have to be at the heart of the strategy. This may mean, for example, A&Es, children’s departments and surgical units at their local hospital either closing or providing a different type of service.

Such a process can significantly improve patient care. But if it is to be managed well and properly provide the highest quality care in the best clinical environment, it must directly involve doctors, other healthcare staff and the public. This involvement should include a voice in the planning and strategy development for such services, thereby ensuring appropriate service reconfiguration driven by clinical evidence and not simply the need for financial savings.

Professor Neil Douglas, Academy of Medical Royal Colleges, Professor Ian Gilmore, Royal College of Physicians, Professor Steve Field, Royal College General Practitioners, Professor Hugo-Mascie-Taylor, NHS Confederation, Professor Sabaratnam Arulkumaran, Royal College of Obstetricians and Gynaecologists, Professor Terrence Stephenson, Royal College of Paediatrics & Child Health, Professor Dinesh Bugrha Royal College of Psychiatrists, Dr Peter Nightingale, Royal College of Anaesthetists, Dr Neil Dewhurst, Royal College of Physicians of Edinburgh, Professor Andy Adam, Royal College of Radiologists, Mr John Lee, Royal College of Ophthalmologists, Professor Alan Maryon Davis, Faculty of Public Health Medicine, Dr Richard Tiner, Faculty of Pharmaceutical Medicine, and Professor David Coggon, Faculty of Occupational Health.

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2 responses to “Royal colleges speak out in favour of service reconfiguration”

  1. MC says:

    It is perhaps of note that the signatories of the letter do not include any of the ‘great and the good’ from Surgery, Accident and Emergency and Paediatrics and I think it likely that most if not all work out of central hospitals and in towns which would not be affected by the changes.

    “This may mean, for example, A&Es, children’s departments and surgical units at their local hospital either closing or providing a different type of service.”

    Change is fine as long as it does not involve me?

    The logical end point of the proposals would mean that there would be no local functioning DGHs. If you remove those services to the centre and some more minor services into the community, the remainder is neither financially viable nor safe.
    If you wish to make such changes then you need to be up front and tell the poulation that they are going to lose their local hospital and that services will be provided at a regional hospital serving a population of at least 800,000.

  2. Bob Bury says:

    Well actually, the President of the Royal College of Paediatrics and Child Health did sign the letter. The case for trauma centres (I thought) had already been made, with an established evidence base for centralisation. Which just leaves the surgeons - but they were never likely to be at the forefront of those pressing for change, were they?

    And to be fair, the letter does make the point that patients will have to travel further in order to access the best care. Just a pity it had to be in the Guardian. Good thing we’ve got Mike to read it for us.

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