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Exclusive: NHS efficiency drive won’t close whole hospitals, says Sir David

No “whole hospital” will have to close as a result of the drive to find £20bn of efficiencies from the NHS budget, NHS chief executive Sir David Nicholson has insisted to HSJ.

Sir David’s claim comes as an increasing number of leading health service figures call on the government to face up to the need to close hospitals which are financially unviable in the new NHS economic climate.

In an exclusive interview, the NHS chief executive said: “In none of the [regional NHS savings] plans I’ve seen has [hitting the savings target] involved closing a whole hospital.”

Stressing that he believed he had seen “all” of the quality, innovation, productivity and prevention plans developed by NHS regions, he said: “From the evidence I have seen, it is perfectly possible to deliver your QIPP savings without closing hospitals. That’s not to say you don’t need big service changes.”

Sir David’s comments came after King’s Fund chief executive Professor Chris Ham criticised politicians for ignoring “clinical and financial evidence” and backing “campaigns to keep local hospitals open”.

Professor Ham wrote in The Observer: “Financial pressures are increasing by the day and will adversely affect quality unless ministers recognise the urgent need to change the way services are provided.

“Up to 20 hospitals may not be financially sustainable and will have to be merged or taken over. Many others face financial or clinical challenges that require changes to the services they provide.”

Royal College of Nursing chief executive Peter Carter last week told The Times there were “far too many acute hospitals” in metropolitan areas. He said the decision to reconfigure would be difficult because of political interference, but that a “paradigm shift was required”.

QIPP schemes across England show commissioners planning to move large sums out of the acute sector.

For example, Trafford Healthcare Trust in Manchester faces its core contract for acute work being cut from £75.5m to just £39.5m over the next five years, while the South East London cluster plan involves taking £126m out of its main providers over the next four years.

Meeting the demands of QIPP plans may be made easier by the decision to drop the blanket April 2014 deadline for all NHS trusts to become foundation trusts. 

Sir David told HSJ the foundation trust authorisation process was being used as the “mechanism” to ensure the “sustainability” of trusts.

One senior SHA official said: “The 2014 date could have forced us down a route we didn’t need to go down. Relaxing the date gives us more time to work plans through.”

The chief executive of one non-FT told HSJ he was “glad” the deadline had been dropped as increased scrutiny for would-be foundations was placing an additional burden on trusts at a time “when the money is also getting tight”.

Readers' comments (14)

  • That's because no body is brave enough to say it...hospitals with 50% activity will need to be closed.

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  • Oh Dear - heads in the sand time

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  • ref. 12.22pm, and writing with a non NHS background, could Sir David explain to me how a half empty acute can possibly function, whether or not the local MP and the (uninformed) community want it to?

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  • We all know that certain specialties cannot exist without a range of complementary on-site services - On a more strategic note, the population are sufficiently realistic to know that public sector reform can't happen by rationalising your pasta supply issues! So you may as well get on with the closures.

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  • Is there some kind of job swap going on between Ministers and the DOH ? Nicholson seems to speak like a politician and Lansley acts like some head in the clouds DOH 'policy wonk'?

    P.S. Perhaps the reason that David Nicholson has not seen any closures in the savings plans he has read is because they won't save the required sums!

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  • Turkeys & Christmas?

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  • I suppose it depends what "whole hospital" means but if we are driving forward with care placed in the community it becomes obvious hospitals cannot continue to function in their current configurations. Bailouts of the size of Heatherwood and Wexham just are not sustainable.

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  • phil kenmore

    I dont think this is really news at all. By 'closing hospitals' most of the public mean their local acute site (whatever that is). You can still 'close' organisations through merger/acquisition but keep sites open in reduced fashion.

    The real issue - and the Politically unpalatable one -is about genuinely relocating patient access to individual services - which always seem to be locally 'cherished' (at least by the sitting MP) when under threat. This despite often delivering poor quality services and worse outcomes than others within reasonable travelling distance. The chances of ever Politically being able to close whole organisations INCLUDING all their facilities/sites are slim to non-existent.

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  • is that because we are not honest with the public about how unsafe these hospitals are? the public dont seem to link Mid Staffs with their local unit but maybe we need to help them do so?
    we are contiuing to deceive if we pretend that small hospitals, surroundied by big teaching hospitals, can offer good care even once down sized. we are colluding and making services more unsafe with political compromises like urgent care centres (rather than lose your A and E) and stand alone midwifery led units.

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  • anon 8.06 is spot on

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  • Sir David's words are very reassuring, almost in fact as reassuring as those of Neville Chamberlain on his return from Munich...

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  • A Q for GPs to ask may be whether DH is proposing reforms designed to shift the job of dealing with public ire at closing hospital services, wards and even whole hospitals (esp DGs) from DH to GPs? The 2006 and 2008 white papers set out a clear strategy and I suspect the coalition just didn't fancy being the party in power when the closures started to bite. If traditionally high public regard for GPs turns against them, they will be decimated, publically and politically. I'm doing some research/survey work on this subject and majority of public say decommissioning will adversely affect their relationship with own GP and of the profession as a whole. GPs should take a long view at the consequences of reform, not just what's in it for them, as they may have a nasty shock waiting for them in 3-5 years time.

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  • Anon 2.04:
    Mid Staffs wasn't a half empty hospital. Not especially small, either. A hospital isn't safer because it has been renamed University Hospital XYZ, either, which most seem to have done in the last decade or so.

    I do agree with the other point made though: a hospital can't lose 50% of its activity and still be what we would recognise today as a hospital. Not a solvent one, anyway.

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  • The real issues, alluded to by most of the correspondents above, are:
    For the public -- will they still have an accessible hospital?
    For everyone -- will the closures be strategically planned, or will they come about through the unco-ordinated hacking about by axe-waving rival consortia?
    Any closures, if they are to be palatable to either the public, the politicians, or to NHS staff, MUST be strategically planned, well thought-through, and logical. No-one will want the dirty work to be carried out by oafs.

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