The consensus that 'hospitals must close' (The Times (London) p1, June
5), even although it seems to be widely supported by politicians,
managers and clinical 'leaders', is a dangerous one.
Safety, quality and economy may indeed dictate fewer, larger
hospitals. This is about complex and 'high tech' medicine. But to
argue that hospitals and beds must close to allow the money to be
spent on 'community services' - a wholly separate issue; about 'low
tech' care - is a recipe for disaster. Politicians and managers have
been consistently and hugely over-optimistic about the role of
community services in keeping people out of hospital. Many clinical
leaders have believed too much of the rhetoric, in good faith.
'Inappropriate' pressure on A and E comes disproportionately from the
chronically ill, the elderly and the frail (and often mentally ill or
mentally declining), as well as anyone 'out-of-hours' ie evenings,
overnight, early morning, weekends.
Genuinely reducing this demand is a bit like reducing the demand for
private transport through public transport and an 'integrated
transport policy' - the alternative has
to be excellent and immediately accessible. (Only one or two European
countries have succeeded.) Even if GP services were available PROPERLY
'out of hours' and the community was crawling with district nurses,
this would not be
enough. Polyclinics with senior specialist medical care would be needed.
And the reality is that hospitals and beds will be closed without adequate
services in the community in many locations. Take North Stafforshire, where
I chaired the hospital Trust and which has signally failed over fifteen
years to develop community services of the quality and quantity to obviate
hospital demand. The acute hospital is punch-drunk with uncompensated care,
and flooded with emergencies. Its managers are routinely replaced as an
irrelevant 'solution' to the problem of missed targets and financial
deficit.
Only if quality community services exist BEFORE beds are closed will
'collapse' (op.cit., p1) be avoided. And if the real problem underlying the
consensus is 'financial ruin' (op.cit p1), fat chance of that. Only in
the English
NHS would the answer to hospitals being flooded with desperate patients be,
'close hospitals'!
Calum Paton
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