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C
onvincing the public that there should be fewer
hospitals, and that they should no longer be the main clinical and philosophical operating ‘unit’ within the NHS, will not be easy.
A shift to more community-based services will, among many other things, save patients time and effort and unnecessary hospital stays, and will be vital to deal with the ever-growing demands of treating people with long-term conditions, and an ageing population. It is well established that the acute sector is not best-placed to cope with these demographic trends in an effi cient way, especially in a future NHS with greater cost pressures.
But hospitals remain totemic, and the political battles to keep them open in local areas have become almost the stuff of cliché, with few politicians of whichever stripe (however senior) and few councils ever prepared to countenance their closure or contraction, despite the fi nancial and/or clinical reasons for doing so.
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If service reconfi gurations remain piecemeal and local, this will continue to be the case – despite the sterling efforts of some very senior fi gures from healthcare to kickstart a national conversation on the issue, there is not much of a sense yet that the debate has reached beyond the medical and political and media worlds into the public consciousness.
Stay informed, stay in front
This is not to underestimate ‘the public’ – many consultations have shown that, given the chance, and once engaged in an issue, people are perfectly capable of considering and balancing diffi cult arguments and realise that funds are not infi nite, and neither are clinicians’ time and resources.
Unfortunately, there is a real fear that pressing hard on this issue now will simply associate hospital closures or service changes with the wider public sector cuts, or with the NHS reforms – rather than clinical needs in the long term.
The three debates fl ow into each other, to some extent, so that would be understandable: but it would also mean a great number of people instinctively taking a hostile attitude to changes at ‘their’ hospital, if they are seen as being linked to a Government-driven spending squeeze, not as part of an NHS-led reprioritisation of service provision away from hospitals and into the community in patients’ interests.
Even within the health service, the debate is still very much alive – and some might argue that more home-based and community- based care should come on top of existing acute hospital capacity, not instead of it.
Others may resent the linked and growing impact and infl uence of social services and local authorities in the health arena because of the growing importance of social care: there have been a number of turf wars already, since people’s health needs and their social care needs fl ow into each other in a way that budgets rarely do (notwithstanding the £1bn of NHS funds reallocated to social care services, and, ultimately, to councils, in the early days of the Coalition).
When the reforms are done and dusted, and when the public fi nances are looking rosier, this debate will still be raging – and the acute sector will no doubt still be relatively too large and have too much prominence in the public mind.
national health executive Sep/Oct 11 | 3
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