By Richard Johnstone | 5 June 2013
The NHS faces a 'vicious spiral' of poorly planned services and unsustainable demand for care unless changes are made to local health care provision and some hospitals close, a coalition of managers, doctors and patients has warned.
The NHS Confederation, National Voices and the Academy of Medical Royal Colleges said the health service in England must be organised differently to provide better quality care, which meant some hospitals would need to be closed down.
This is the first time bodies representing all three major parts of the health service – patients, clinicians and senior leaders – have called for reforms together.
Today’s report, Changing care, improving quality, said public reaction to planned hospital changes in the past, which have been driven by financial or clinical problems, had polarised the debate about reorganisation. This meant the NHS was at risk of being paralysed in its current state, even though major change was essential to deal with rising demand and limited funding.
The report concluded that the health service must do more to emphasise a ‘whole system’ approach, so communities did not see hospital closures as a loss but understood that reinvestment in community services would lead to better services.
Published on the first day of the NHS Confederation's annual conference, the report set out five recommendations for local health service bosses to ensure essential reconfigurations could proceed. These included ‘more meaningful' involvement of patients in the development of any reform plans, being honest about the financial risks across the system, and involving clinicians so they could help communicate the changes.
National NHS chiefs and government ministers were urged to set out a national vision for community-based health services, so local changes could be seen within this context.
A number of structural barriers hindering local changes had also to be addressed. These included the existing payment-by-results system for hospitals, which is currently being reviewed by health sector regulator Monitor and the national commissioning body NHS England.
NHS Confederation chief executive Mike Farrar said the health service ‘must overcome its paralysis in relation to change, and it must bring the right people with it’.
He added: ‘The onus is on us in the NHS to build the case for change among the people we need support from, so that “reconfiguration” stops being a dirty word and starts to represent the kind of planned, well-evidenced change programme which the NHS deserves.’
National Voices chief executive Jeremy Taylor said patients were not being best served by the current pattern of services.
‘For the safest, highest quality care, hospitals need to be organised differently and more services are needed closer to people’s homes. But the changes needed are often highly controversial. The NHS has often failed to make a good case to involve patients and communities in ways that would build trust and to follow through to ensure that the new pattern of services is better than the old.
‘We need a more honest debate and a better way of making the decisions. This should not be about the NHS getting smarter at public relations, but about working with patients and citizens to jointly shape the decisions.’
Professor Terence Stephenson, chair of the Academy of Medical Royal Colleges, added that changes to how care is provided were needed to deliver high quality provision in the future. ‘We want to create a culture of joint working, where it is normal for patients to be involved in every stage of designing their health care,’ he said.
