Dr Phillip Lee is MP for Bracknell.
‘NHS reconfiguration’ is a phrase often synonymous with ‘hospital closures’ or ‘cuts’. The actual meaning requires a few more words and does not fit quite so neatly into a dramatic headline.
Reconfiguration of health services actually means better services, more sharing of clinical expertise and, crucially, more lives saved. The premise behind reconfiguration (and I accept it’s not a very PR-friendly word) is that there will be a number of large acute hub hospitals with a series of community hospitals that have links to the hub. This will mean that more clinicians will be co-located, leading to greater sharing of expertise and ultimately better care for patients. This has already been demonstrated by the reconfiguration of cancer care and stroke surgery in London where we’ve seen huge improvements in outcomes for patients.
There have been several significant papers published on what reconfiguration could look like, including Facing the Future from the Royal College of Paediatrics and Child Health; Hospitals of the Future from the Royal College of Physicians and Seven Day Consultant Present Care from the Royal College of Surgeons in England. These reports all agree that consolidated care is necessary for a sustainable and outstanding health service in the future. We need an overarching and specific national plan that pulls all of these together, including firm proposals for where and how care will be delivered. Localism works in many respects, but on this we need a firm national plan.
I recognise that there are significant obstacles to reconfiguration, not least of which are the political challenges. Opponents to reconfiguration will say it is simply a euphemism for cuts; this is not true. It is about delivering better and more efficient care for patients. Yes, savings will be made, but this is an inevitable product of consolidated services and this extra benefit should be celebrated not castigated. Such savings will help to fund continuing health care in an increasingly ageing society.
Of course, the reconfiguration argument is not helped by some recent reports, such as the Safe and Sustainable review into congenital cardiac and neurological services for children, where consultation was poor and the review took far too long.
However, there have also been excellent examples of how to reconfigurate, such as Manchester’s maternity services. Here there was proper public consultation, a clear clinical case and deadlines were adhered to. Talking to political colleagues it is clear that many agree with the concept of reconfiguration but are afraid of the political – and, ultimately, the electoral – consequences of voicing that support. While there is cross-party support on this, there is largely cross-party silence.
We need to do more to encourage clinicians to come out publicly in support of the changes. Clinical leaders across the Medical Royal Colleges are in favour and eager to press ahead. Dr Hilary Cass, President of the Royal College of Paediatrics and Child Health, spoke passionately in favour of reconfiguration at an event I recently hosted in Parliament. Clinicians ought to be encouraged to do this more often and more publicly.
It’s inevitable that some people will have to travel further for appropriate care. However, when they get there they will receive better medical attention. In addition, those who use outpatient services at the local hospital may actually travel shorter distances for their appointments, as these services move to community hospitals and to GP surgeries. Of course, more rural areas present a key challenge: these need to be addressed first; otherwise the debate will be lost before it’s even begun.
Reconfiguration is going to happen as pressure on services continues to grow. It has to happen if lives are to be saved. We now need to make a choice: do we campaign proudly on the benefits of reconfiguration or do we take the easy option of keeping quiet and only reconfigure at the last moment, when we reach crisis-point?