Keep the NHS political
Is it shortsighted and parochial to campaign to save local hospital services? This was the theme of a radio interview I listened to last week with Joan Ruddock and Ara Darzi. Darzi was arguing that politicians can be too defensive and parochial in their health campaigns and that his review of stroke services in London, which has brought better and safer services, would have been prevented by this sort of campaigning. Darzi contributed an enormous amount to Labour’s progress on healthcare, but he was wrong to allow himself to be used in opposition to the current campaign to save services at Lewisham hospital or, in fact, many others around the country including the excellent Save the Alex campaign in my former Redditch constituency.
In my view, there is a clear distinction between reform to improve the quality of services backed up with robust clinical evidence which is fully communicated to those most affected whether staff or patients and cuts to the quality of basic hospital services due to financial or recruitment issues which should and could be tackled. The Lewisham case is clearly about cutting the services to one part of south London due to financial problems in another part. You don’t need to be a highly qualified clinician to know that this is wrong.
The Redditch story is more complex and has been going on longer, but demonstrates why local politicians have a key role to play. There have been three attempts in the last 15 years to downgrade the A&E and maternity units at the Alexandra Hospital, Redditch. On each occasion, the argument has been that this is crucial for sustaining a high-quality, properly staffed service and that it will be better for people if services are concentrated in Worcester (over half an hour away in a car). I led the successful campaigns against these proposals on the previous two occasions as the local MP. My arguments were threefold.
First, A&E and maternity are core hospital services. For most healthy working-age people, their only contact with a hospital is likely to be in one of these two services. It isn’t unreasonable to expect that they’ll be delivered in mainstream NHS district hospitals. I accept the argument that there are some services – stroke, specialised surgery, rare diseases – where evidence does suggest that concentrating specialist skills and resources in fewer centres can save lives. I supported changes in these sorts of cases as the local MP even when it meant removing some services from Redditch or other nearby hospitals. However, those responsible for managing the NHS should not underestimate the significance of accessibility to core services for maintaining support for a publicly funded NHS.
Second, clinicians should certainly be asked to provide expert analysis and recommendations, but they don’t always agree and they’re not always impartial. I never saw any clear evidence of clinically better outcomes for the proposals to downgrade services in Redditch. Clinicians in one part of the county often disagreed with clinicians in another part or with GPs. There was a strong case made that there was a shortage of clinicians willing to work in Redditch, but I pointed out that this was likely to be because there was a constant threat hanging over the departments. Furthermore, when consultants became willing to travel between sites or share their rotas, this problem could be solved. This is an HR problem, not a clinical one, and it needs strong managers to solve it, not to cave in and start organising services for the benefit of clinicians rather than patients.
Third, politicians can often point out that the decision-making bodies for reconfigurations of services are political and bureaucratic constructs. Redditch is as accessible for the Birmingham trusts as it is for Worcester. However, there is very little imaginative thinking about how boundaries can be crossed either by patients or staff in order to provide better and more convenient services. I pushed for this in the last Redditch campaign. Last week, those involved in the current Worcestershire ‘service review’ admitted that they’ve begun to make the links across boundaries again. It’s taken a year!
Let’s resist the calls to keep politics out of NHS reorganisations. The NHS is not apolitical – it was formed from political conviction, it is funded by political decisions and its core principle of healthcare free and accessible at the point of need is the basis of its considerable public support. Local politicians and local people should be at the heart of decision-making – however difficult it is.
Ara Darzi, health, Jacqui Smith, joan ruddock, Lewisham, NHS