The Independent View: The chilly reality awaiting health policy

For an issue that ranks second only to the economy in importance for voters, the campaign debate on the NHS has been oddly disconnected from the chilly reality that awaits it beyond May 7th: a significant reduction in the generosity of funding compared to the past ten years, regardless of which party comes into power. Most parties have been making offers in their manifestos with resource implications: more single rooms, shorter waiting times for cancer tests, more choice of GP. But on the whole there has not been much discussion of the need to save, beyond the ubiquitous offers to cut out bureaucracy and waste, as though that might be enough.

All the parties are promising to protect frontline NHS spending to some degree, but an ageing population will place more demand on health services, coupled with higher costs. The NHS has been warned by the Department of Health that it needs to make efficiencies worth between £15 and £20 billion by 2013/2014. This is equivalent to productivity gains of between 5% and 7% a year, each year, for three years, a massive reversal of current performance given the 0.4% fall each year in NHS productivity over the last decade.

There is no doubt that the NHS has made progress in the past decade: waiting times for hospital care have reduced substantially, there have been reductions in two healthcare associated infections (MRSA and c difficile), mortality from cancer and cardiovascular diseases has continued to fall. But while smoking rates have continued to decline, rates of obesity and harm caused by alcohol abuse have risen. Chronic illnesses such as diabetes are increasing and will continue to rise as the population ages. Meeting these challenges requires a different kind of NHS to the one we have now: more geared to prevention and effective treatment outside hospital. This is not a new diagnosis:  shifting the model of care to one based on community and primary care has been an ambition for many years. But the political energy has always been directed at hospitals, whether setting exacting targets for waiting times or rolling out a programme of Foundation Trusts with new governance arrangements and new financial freedoms.

All this means changes to local services are a necessity not an option. Even if there were no financial imperative, changing technology means more can be done outside hospital or without a hospital stay, while some services – particularly trauma care and other very specialized care – need to be concentrated in fewer centres for maximum benefit. This means hospitals will need to change shape and some services will need to close, particularly if money needs to be saved and reinvested elsewhere.

And here is the problem: the Conservatives have already announced that they will stop ‘forced’ A&E and maternity closures while Labour have ducked the topic in their manifesto. Nick Clegg has spoken of the need to find savings, but the Lib Dem manifesto complains that local services keep being closed “even though local people desperately want them to stay open”.

Where I live, all three political parties have pushed leaflets through my door claiming that they will “save” the local hospital (in fact what is being proposed is a downgrade of the A & E department, not the closure of the entire hospital). There is no attempt to engage the voters with facts or reasoned arguments about the debate, it is simply held up as a Bad Thing That Must Be Stopped.

All three political parties need to start talking in a positive way about the need for local services to change. Unless this happens, it will be difficult for the NHS to deliver the efficiencies needed and there will be a temptation to make cuts to less visible services, often serving the most vulnerable and least vocal.

Ruth Thorlby is a Fellow at The King’s Fund and one of the main authors of our recent publication ‘A high performing NHS? A review of progress 1997-2010’ available online.

The Independent View‘ is a slot on Lib Dem Voice which allows those from beyond the party to contribute to debates we believe are of interest to LDV’s readers. Please email [email protected] if you are interested in contributing.

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This entry was posted in Op-eds and The Independent View.


  • Melissa Brown 24th Apr '10 - 2:16pm

    Exactly. But I didn’t notice that waiting times for IVF treatment have reduced. At least in Scotland. My desire to have children failed because I’m 39+. It’s very difficult for us to get funding for patients over the age of 39.
    When you’re 39 or 40 you’re stuck. NHS local services waiting lists for fertility treatment are up to 2 years. 75% of IVF cycles in the UK are still carried out in the expensive private sector. BBC said that hundreds of Briton couples travel abroad every month for ivf and egg donation because they cannot get it at home. Thank you for your post.


  • several points have been either overlooked or not taken into account here.

    Firstly, changes in medical technology should not be used as a yardstick for closing or transferring some local hospital services to another centralised ‘larger’ hospital many miles away.

    In any public service, changes to services provided locally should never be forced upon people simply because clinicians or other medical bodies say it is in the best interest of the public. For example, in 2007 Burnley General Hospital had its A&E services removed and transferred to the Royal Blackburn Hospital fifteen miles away. The consultation was a sham, and the Labour governments NHS reforms went ahead contrary to the wishes of almost the whole population of Burnley itself. The ultimate decision to close Burnley’s A&E rested in the hands of a scrutiny committee that consisted of mainly Labour councillors.

    The centralisation of hospital services at Blackburn took no account of the population catchment area. The royal college of surgeons recommended an A&E to serve a 300,000 population catchment, yet East Lancashire had a population of nearing 600,000. Knowing this, the government increased the population catchment from 300,000 to 450,000. They simply plucked the figure of 450,000 out of thin air to ensure the larger trust areas correlated with the reforms. Absolutely ludicrous. The result of course was inevitible, due to over-capacity, the only A&E hospital at Blackburn serving the whole of East Lancashire closed its doors temporarily sending patients to hospitals elsewhere in Lancashire. Of course, there is more to it than that, quality of patient care suffered greatly with at one stage up to fourteen ambulances queueing outside the Blackburn super hospital.

    In contrast, your article mentions these changes should go ahead even if there were no financial imperative. In other words, these changes should go ahead on solely on a ‘clinical’ basis with scant regard to how much it will cost, be that the financial cost, or the resulting cost in lower standards of patient care.

    It’s important to remember that specialised care was already being provided in many local hospitals before the untrialled NHS reforms were rolled out. Hence there are no grounds to say any changes were not based on financial viability, which, if you analyse the majority of trusts, was a prime factor when deciding to centralise hospital services. I refer you to the mid-staffordshire hospital scandal on how NHS targets and competition between hospitals (scrambling to gain foundation trust status and payment by results) can lead to thousands of patients dying unnecessarily.

    I feel it is unfair to say that all political parties have no reasoned argument and that they are simply saying closing hospital services is a bad thing that must be stopped. The Worthing & southlands hospital (WASH) campaign for example was supported by all parties including doctors and provided a fully comprehensive report to retain hospital services locally. Thankfully, the evidence provided by WASH resulted in retaining services locally thus potentially avoiding another mid-staffordshire disaster.

    When people see their local hospital losing services piecemeal they have good reason to believe that at some stage their local district hospital will be nothing more than a domocile to a larger super hospital many miles away. Quite rightly this is nothing short of losing the hospital altogether.

    With an increasing and ageing population, more hospitals are needed, not fewer. Traumas and emergencies need to be dealt with quickly to increase clinical outcome. When a serious trauma patient needs treatment, time matters, one hundred specialists in a super-hospital 15 miles away is no substitute for a handfull of specialists in a nearby hospital who can treat the trauma patient within minutes.

    Nobody disputes clinical outcomes may be better for tertiary services and elective hospital services. But seperating acute services from elective by vast distances was ludicrous. Applying this to the Acute/emergency sector was foolhardy and imposed upon people without their consent simply because it was in their ‘best interest’.

    The Liberal Democrats have clearly laid out in their manifesto how the current inefficiences in the NHS are having an impact on patient safety and care and how this will be addressed. Something that simply cannot be printed in a leaflet that lands though your door. There are now more NHS managers in the NHS than there are NHS beds. These NHS reforms didn’t anticipate that such a large degree of management and administration would be needed. Which of course defeats any argument that finance isn’t, and would not be, an issue when implementing the untrialled reforms that have seen so many patients suffering for the sake of technological advances.

  • The policy of closing down specialist care locally and moving it to regional specialist centres is madness and will be responsible for the death`s of many people especially those with heart and stroke problems.
    I suffer from Pulmonary hypertension and my specialist centre is a two hour drive from my home.This illness makes you very tired and breathless and to have to travel that far does not do your condition any good at all I can tell you.
    We should be localising care not moving it away from people.,We need more local hospitals and more beds not less.That will be hard to achieve in the present climate but when we are able to find billions to fund the weapons of war we should be able to find money to fund a service about life not death.

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