Jeremy Lefroy is Member of Parliament for Stafford. 

A recent report into the future of hospitals by the Royal College of Physicians pointed out that in the UK we have 61 approved specialties, whereas in Norway there are 30.

This relatively high number increasingly poses problems for the NHS. Many specialties will require a separate rota of consultants and other clinicians. This will increase the cost and reduce flexibility compared with a more general rota under which a clinician would undertake a wider range of work.

Many services are therefore likely only to be offered in the largest hospitals, when previously they would normally have been carried out in local district hospitals. Clinicians, too, will be guided down increasingly narrow career paths with less flexibility than in the past. Shortages will inevitably arise in some specialties which cannot be met by rapid retraining. We are already seeing this in critical areas such as Accident and Emergency medicine.

The Royal Colleges and other professional bodies which oversee the specialties are becoming increasing stringent in what they define as adequate staffing for specialist rotas. The pressure to close in-patient children’s beds in any hospital which does not have a rota of at least 8-10 consultants is growing all the time. That would probably mean the closure of at least 50 units in England, if not more.

I recently heard of one specialty which has come out with guidelines which would mean that district hospitals may no longer be able to offer in standard operations which we would consider to be commonplace at the moment.

All this is being driven by professional bodies largely based in London or the big cities. It is true that the European Working Time Directive has introduced an inflexibility into NHS rotas which exacerbates the problem. But there is no doubt that many clinicians who value the work done by district hospitals in dealing with very large numbers of ‘general’ cases are increasingly concerned with the ever-increasing influence of the specialties. This poses a threat to the long-term existence of general NHS hospital services which are reasonably accessible to everyone in the country – not just those in the large urban areas.

Perhaps it is also time for the medical professions to take a look at their career structures so that they can adapt more easily to changes in demography, burden of disease and patient needs.  The increasing revival of discussions about the specialism of general medicine – clinicians who can take a holistic view of a patient’s condition, referring him or her to a specialist only when necessary – points to one way forward.

It is time for ministers at the Department of Health, and the NHS itself, to enter into a serious and public dialogue with the royal colleges about this. There are major consequences to NHS finances, access to health services and medical training resulting from the decisions which the professional bodies are taking. Yet they are not openly debated with those whom they affect the most – the patients for whom services, general and well as specialist, will increasingly become less accessible.

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