Home - SR Editions - Socialist Resistance No.48

New evidence undermines the case for hospital closures

John Lister

TWO recent top-level academic reports have struck body blows at the drive towards “centralizing” more hospital services and downsizing many hospital Accident & Emergency departments to “urgent care centres”.

First came Sheffield University study, carefully weighing evidence and information to draw the apparently common-sense conclusion that longer ambulance journeys for treatment can have a seriously detrimental impact on the survival chances of some groups of patients. This has been stubbornly and indignantly denied by NHS managers seeking to close down A&E units and obliging patients to travel further, and by ambulance trust bosses eager to trumpet the skills of their workforce and the impressive range of lifesaving equipment that is now carried in emergency ambulances.

Their response to the Sheffield study was to rubbish it, pointing to the fact that it is based on information that is now seven years old. However, this is the most recent and most detailed study of the issue to be carried out, and not that much has changed in terms of resources and training of ambulance staff that would question the findings.

Ambulance crew themselves, while justifiably proud of their skills, also point out the difficulty of conducting life-saving treatment and using sophisticate equipment in the back of a swaying ambulance and the importance in many cases of getting the patient to hospital in the shortest possible time. In other words plans such as the Hertfordshire proposal to close A&E and other frontline hospital services at Hemel Hempstead and Welwyn Garden City (QEII Hospital) do pose a potential threat to the lives and future recovery of patients who would then face much longer journeys along highly congested roads to Stevenage ( Lister Hospital) or Watford General Hospital.

But the second major report struck right at the heart of the whole rationalization programme across the NHS: a 154-page study by the Academy of Medical Royal Colleges, published in September, has concluded that there is no evidence that most patient care or safety is materially improved by concentrating all hospital services into fewer, bigger hospitals.

There is limited evidence that outcomes for patients who have suffered major trauma, or need neurosurgery or vascular care fare better in more highly specialized units.

But: “At this stage, any decision to withdraw 24-hour surgical cover from some hospitals in favour of centralization is not supported by current clinical evidence”.

And even more damning in response to the cash-driven process towards centralization of services, the report also argues that services must be “delivered as locally as possible ” without compromising safety and quality, and: “The Royal College of Surgeons insists that any reorganization of health services has a sound clinical and evidence base. Financial, political and managerial expediency must not be primary drivers for service reorganization. ”

Ministers should be further embarrassed that the RCS also points to New Labour’s own market-style “reforms” of the NHS – the system of “payment by results” and the deliberate creation of competition between NHS providers – as obstacles to joint working and barriers to change. Of course the conflicting evidence is not enough on its own to force back the management offensive, which is very much driven by the cash pressures in an NHS which is now constantly claiming that it is in balance or even in surplus, while beneath the service frantic efforts are being made to cut back mental health and hospital services to balance the books.

One Hertfordshire manager responded to the Royal Colleges’ report by arguing that it is “just a point of view”. It’s very much up to trade unions to marshal the evidence, inform their members and encourage them to fight back for jobs and services – and give a lead to local campaigns which are continuing to challenge local cutbacks and centralization.

Darzi challenged on NHS cuts and closures

Pressure group Health Emergency have challenged the Government to come clean on whether the Darzi report on the NHS - published on October 4 - means an immediate moratorium on service closures and job cuts across the NHS.

In the past 18 months over 25,000 jobs have been axed from the NHS and a series of regional reviews have identified a raft of maternity units, A&E departments and mental health services for closure.

Lord Darzi has now indicated that he will be bringing in his own teams of experts in the Regions to look at services with the suggestion that the existing finance-led reviews, and their associated cuts and closures, will be put on hold.

Geoff Martin, Health Emergency Head of Campaigns, said: “Any genuine attempt to engage staff and patients in reviewing the future pattern of local health services would be a positive move and would be a welcome break from the current top-down approach where bureaucrats bulldoze through cuts and closures in the teeth of staff and public opposition.

“However, if we’re to have any confidence in the brave, new world of Lord Darzi the existing cuts-led reviews have to be stopped and the axe that’s hanging over dozens of local hospitals and services must be lifted.

“We are challenging the Government for a categoric assurance on that key point.”