Plan for Wave of Closures of NHS Services

{mosimage} The NHS is preparing a wave of closures of key hospital departments across England in the run-up to the next general election, its new chief executive told the Guardian in his first interview since starting the job. David Nicholson, the man responsible for leading implementation of reforms, said there would be up to 60 “reconfigurations” of NHS services, affecting every strategic health authority in the land.

Some changes will try to squeeze out overcapacity that contributed to the NHS’s £512m deficit in the last financial year.But most will be aimed at redesigning the NHS to improve care by concentrating key services in fewer hospitals.

Mr Nicholson identified A&E departments, paediatrics and maternity services as areas where provision would have to be overhauled. “Undoubtedly there will be tough decisions to make over the next 12 months to reflect changing services,” he said.

He denied that the timetable for reform would require painful closures to be made during a general election campaign. “Some will come sooner. We are going to have to tackle some of these big patient issues … I understand the politics of it. But this is about the way we deliver care which is predominantly closer to home.”

NHS managers are aware that any plan to downgrade these key services at district general hospitals would be likely to provoke intense opposition from local MPs and protest groups. Labour lost a parliamentary seat at the 2001 election when Richard Taylor ran as an independent protesting about the removal of the A&E department at Kidderminster hospital.

But Mr Nicholson was optimistic that the public would back his plans if the NHS could win doctors’ support and explain the advantages of reform to patients.

NHS trusts and the 10 strategic health authorities (SHAs) that oversee their work will go out to consultation later this year or early next “on a whole series of reconfigurations”, Mr Nicholson said. “Each SHA will have about half a dozen,” he added.

The plan is for patients suffering major injuries to be taken to a specialist trauma centre. An attempt will be made to encourage patients needing minor emergency treatment to go to walk-in clinics. This will call into question the viability of running a full A&E department in every district general hospital. Many may be downgraded to urgent care departments.

Mr Nicholson said the NHS also had to tackle the “wicked issue” of maternity services. Pregnant women would be best served by maternity departments big enough to sustain a 24-hour, consultant-led service. That would require work to be concentrated in fewer hospitals. The same considerations applied to paediatric services needing many children in the catchment area to operate efficiently.

While some hi-tech services would be concentrated in specialist centres, many other treatments would move out of hospital into community clinics and GP surgeries. Patients would come to understand that these reforms were about improving services, not cutting them, he said.

He was not aware of the need to close an entire district general hospital to tackle NHS deficits by reducing overcapacity. “Never say never, but the only time I have seen anything so radical is when a new hospital has opened in the area.”

The NHS was, he said, unlikely to deliver Tony Blair’s pledge that all acute hospital trusts should be ready to apply for foundation status by 2008. One answer might be for strong trusts to take over the weak. “I think we will see some of the better hospitals acquiring others,” he said.

Dr Taylor, who was re-elected MP for Wyre Forest last year, said the government might be able to escape a wave of Kidderminster-style revolts if it avoided making key mistakes. District general hospitals should retain enough medical specialisms to have consultants available to handle emergencies in A&E, he said.