The NHS: 65 years to evolve, just 40 days to destabilise?
As the Care Bill works its way through Parliament, one particular part of it, Clause 118 aka ‘the hospital closure clause’ is causing huge concern among NHS campaigners, unions and clinical staff.
When clinicians who have been through years of training and have marked up decades of clinical practice put the words ‘risk’ and ‘patient safety’ together, politicians have to listen. Clinicians do not use patients as political footballs, but dedicate their every moment to providing the optimal outcomes for those they serve.
Medicine is complex because the clinical needs of each of us is unique, so when doctors, scientists, therapists, nursing staff and other health professionals raise concerns, the government is prudent to take heed. After all, wasn’t that the call of the Francis Report – all should be able to raise concerns and all should be heard. The listening has to extend to Jeremy Hunt and his team too.
Unless the NHS is focused on providing the best clinical outcomes, then it has failed in its mission. The London Stroke Plan, hailed by politicians as an example of exemplary working across organisational boundaries, has greatly improved clinical outcomes and saved many lives but it did not happen overnight, nor over 40 days.
Yet Clause 118 of the Care Bill will rush through decisions on major reconfigurations of services in 40 days, with only one clinically focused meeting. This clause will determine the way that services are delivered in financially challenged Trusts and then enable the Secretary of State to order the reconfiguration of services from within these Trusts and also across all organisations in the region, in fact no hospital will be immune.
The high clinical risk that rushed decision making will bring about is frightening. This could destabilise services, mean that specific specialisms are detached from vital support services or mean services aren’t available at the location which would be the safest for the community. No clinician would allow their patients to be thrown into the deep end of rushed clinical provision to see if they sink or swim.
This is why Clause 118 should be scrapped and the government enter into full and proper dialogue with all professional bodies as to how it should reorganise the NHS to improve outcomes. We are not short of evidence-based examples of how we can create a win-win out of this, and we are ready to talk.
The NHS has taken 65 years to evolve, a blink of 40 days to deconstruct services makes no sense to any clinician. Of course change is needed, but instead of continual structural diktats from Westminster and Whitehall, it has to be developed through thorough local clinical leadership, across all professions; with those equipped with the necessary clinical expertise leading the way.
Any politician would take clinical advice when their life is at stake, and yet some are willing to play roulette with the lives of others.
Why not follow the advice of Robert Francis, if concerns are being raised, don’t cover up your mistakes, but learn to listen and address the issue.
There is an easy solution – drop Clause 118 and talk to the clinical experts.
As for the rest of us. We have a short period of time before the Care Bill returns to Parliament – get busy and write to your MP and ask them to put patient safety first and drop Clause 118.
The new legislation would allow the government-appointed Trust Special Administrator (TSA) who takes over a financially failing NHS trust or foundation trust, to make recommendations for reconfiguration of services that affect providers across the whole region. That could mean making proposals to close financially healthy and outstanding hospital services simply because they neighbour another Trust that’s in financial distress.Under the TSA regime, recommendations can be made and submitted to the Secretary of State for agreement through a deliberately speeded up process, with minimal consultation with commissioners, clinical staff, patients or the wider community.
GUEST POST: Rachael Maskell is Head of Health at the trade union Unite