Leading Doctors Support Centralisation of Services

The proposals seem to follow blueprints being laid down by specialist Indian Hospitals. Currently in India specialist hospitals, especially in heart surgery, are being developed in order to deal with the mass treatment of patients. Hospitals deal with a bulk number of patients, are provided with specialist cutting edge technologies and are staffed with a far greater number of specialist doctors. This specialisation is leading to greater operation success rates, improved patient care and more experienced doctors.

Letter to the Guardian

This is the most closely contested general election for more than a decade and health is one of the top priorities for voters and politicians. While we welcome the focus on the NHS, we are concerned that the political debate and its attendant media coverage tend to overlook the cogent arguments for service change that will bring long-term benefits for patients.

There has been a wealth of clinical evidence for many years that specialist clinical services, such as stroke, trauma and heart surgery, should be concentrated in fewer centres. This would allow the latest equipment to be sited with a critical mass of expert clinicians who regularly manage these challenging clinical problems, and are backed by the most up-to-date research. The greater volumes of patients mean doctors are better at spotting problems and treating them quickly. Survival and recovery rates would improve markedly with many lives saved. As techniques and technology have developed over recent years, speciality rather than proximity has become the key for patient safety. So increased patient safety and improved care must be the major drivers of any reconfiguration.

Patients may indeed have to travel further for some specialist care, but if it is significantly better care then we believe that centralisation is justified. However, at the same time there is also strong evidence to support a large amount of more routine care, currently taking place in hospitals, being carried out closer to where patients live in the community with GPs playing a crucial role in the delivery of services.

Delivering this requires strong leadership and brave decision-making from doctors, managers and politicians. Simply condemning change as bad and defending the status quo as ideal is not serving the interests of patients.

If the NHS is to cope with the financial pressures it is going to face under any government without resorting to indiscriminate and damaging service and staffing cuts, large-scale planned service redesign and reconfiguration based on clinical evidence will have to be at the heart of the strategy. This may mean, for example, A&Es, Children’s departments and surgical units at their local hospital either closing or providing a different type of service.

Such a process can significantly improve patient care. But if it is to be managed well and properly provide the highest quality care in the best clinical environment, it must directly involve doctors, other healthcare staff and the public. This involvement should include a voice in the planning and strategy development for such services, thereby ensuring appropriate service reconfiguration driven by clinical evidence and not simply the need for financial savings.

  • Professor Neil Douglas – Academy of Medical Royal Colleges
  • Professor Ian Gilmore – Royal College of Physicians
  • Professor Steve Field – Royal College General Practitioners
  • Professor Hugo-Mascie-Taylor – NHS Confederation
  • Professor Sabaratnam Arulkumaran – Royal College of Obstetricians and Gynaecologists
  • Professor Terrence Stephenson – Royal College of Paediatrics & Child Health
  • Professor Dinesh Bhugra – Royal College of Psychiatrists
  • Dr Peter Nightingale – Royal College of Anaesthetists
  • Dr Neil Dewhurst – Royal College of Physicians
  • Professor Andy Adam – President, Royal College of Radiologists
  • Mr John Lee – Royal College of Ophthalmologists
  • Professor Alan Maryon – Davis Faculty of Public Health Medicine
  • Dr Richard Tiner – Faculty of Pharmaceutical Medicine
  • Professor David Coggon – Faculty of Occupational Health

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