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Jeremy Hunt not reviewing reconfiguration plans

The incoming health secretary is not carrying out a review of hospital reconfiguration plans, contrary to a report, HSJ understands.

The Independent today reported that local proposals - particularly those involving closing accident and emergency units - would be reviewed by Jeremy Hunt. It implied the government would be more likely to block the changes than it has been so far, when service change plans are referred to the health secretary.

The comment will have fuelled concerns that Mr Hunt will slow down or stop major service changes, which are being considered in many areas to make savings.

The Department of Health has not commented directly on the report. However, HSJ understands the DH’s position is that there is no review and there has been no change in policy.

A well placed source said Mr Hunt had not intended to signal a change in the department’s position, although he is keen to stress that major service changes should be supported by clinicians in the area.

HSJ also understands the issue has not been raised with NHS chief executive Sir David Nicholson, indicating it is not a major policy shift.

The DH said in a statement: “Changes to local health services are decided and led locally. Local healthcare organisations, doctors, nurses and other health professionals, with their knowledge of the patients they serve, are best placed to decide what services they need for patients in their area.”

Readers' comments (11)

  • It would be jolly good if there was a U turn - there are simply not enough beds for patients at the moment - and its not quite clear what will happen when more Acute services get closed. The "community" is simply not ready to manage all these complex multimorbid patients, and it would not be fair to deny elderly patients investigations/treatment in hospital when they get ill (chest pains, breathless, delirium etc )

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  • Hear hear consultant physician- the community is not ready because GPs see them as being the lead for this and forget that what we need is a multidisciplinary approach to managing complex patients in the community and sometimes hospital clincians supporting community clinicians . Clinical commissioning has become GP commissioning and squeezed out other clinicians who have much to contribute to a safe shift to more community care

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  • Hear hear both of you.
    Everything is a mess, and the prospects for imrovement are slim whilst acute trusts continue to centralise their services into their acute facilities whilst the community sector (that they picked up under TCS) are being denuded of staff and facilities.
    Certainly a valid point about clinical commissioning now focused on GP commissioning, who will have little idea about how much acute/community services need radical overhaul to meet the vision of 'consultant physician.'

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  • Agree - the whole commission landscape is a mess - and has virtually no prospects of improving anything.
    I will take issue though with the summary of acute Trusts denuding community services under TCS. In my area (Warwickshire) the opposite is happening the acute trust is investing heavily in staff and technology to move the burden of care that shouldn't be in Hospital to better setting for patients. I am sure we are not alone

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  • David Hooper

    I thought the move was towards integrated care. I was under the impression that it is generally recognised that acute hospitals are not appropriate settings for older frail people with chronic conditions. Hospitals are not a good place to live or die!
    Why do so many clamour to put people into hospital when there are better and safer environments for them?

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  • Glad to hear it for Warwickshire. Sadly it is not universal.
    "All they wanted is our money, not our services" is what I hear from our local ex-Community staff.

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  • David Hooper is right that hospitals are not good places to live or die. They are good places to receive episodes of treatment.
    The clamour to put people into hospitals comes because as yet there are too few environments that are better and safer for the old/chronically sick/multiply co-morbid who become acutely unwell.
    The transfer from secondary to community care is not going to happen any time soon as there are too few mechanisms for transferring money to community services, and probably too little money in the system overall

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  • I've always thought the answer is pretty obvious. If you want better integration between acute and community services, you should integrate acute and community organisations. It's considerably more difficult to have an "us and them" situation if there is no "them".

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  • The need for service reconfiguration, with fewer hot sites, is very pressing across London (I cannot speak for elsewhere). It is difficult or impossible to achieve high quality care in numerous small facilities. We've learned how much better consolidated services can be with stroke, percuaneous coronary interventions and trauma. The same principles apply to emergency medicine and surgery, maternity and paediatrics.
    I'm heartily relieved that Mr Hunt is not intending to call in the proposals for review, but still very nervous that local politicians will, as ever, put political expediency before patient care.

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  • There is a misconception that the benefits seen with centralising stroke/trauma/primary angioplasty apply to all other acute medical emergencies . There is good evidence that rapid access ( journey time) is perhpas more important for survival in conditons such as respiratory distress from pneumonia or septicaemia. There is a misconception that most frail elerly people are rushed into hospital for social care. In fact the more frail they are, the more likely they are to develop sepsis, diffiuclty breathing, chest pains , loss of consciousness, delirium,fractures etc etc none of which can be easily treated in the "community" ( no fast acces to Xrays, bloods,IV, blood gases, drugs, medics etc). It is true discharges need to be sped up from hospital - but by closing a third of the hospitals, the main users of our acute services( the over 70s) will have to travel much further for secondary acute medical care to a tertiary centre instead- and probably clog up beds and make access even more difficult for those genuinely needing teritiary care?The elderly and the frail have a right to expect access to necessary treatment ?The sheer numbers of patients who will then flood the tertiary centres are likely to make the workload and capacity unmanageable without major expansion/build of wards in these tertiary centres? The Bristol reconfiguration is a good example to look at.

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  • Very useful comments, consultant physician. I must confess to struggling with this re-design myself. Our MIU was really a dressing station - we didn't have proper medical cover, no XR, no community ECP, all our PGDs for nurse prescribers needed updating...... Our OOH was good but winter pressures were a nightmare and on the whole it felt like trying to put a jigsaw puzzle together where you have a shared understanding of the picture on the box (we have strong clinical leadership locally and the Boards were all supportive) but no one could quite fit all the pieces together properly because of various conflicting policy drivers.

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