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UCLH chief fears CCGs could bring more fragmentation

One of England’s most respected hospital chiefs has said he fears clinical commissioning groups could lead to care becoming increasingly fragmented – and that rationalisation of acute services is “happening behind the scenes” without their input.

Sir Robert Naylor, chief executive at University College London Hospital Foundation Trust, was speaking yesterday during the HSJ debate at the Commissioning Show in London.

Asked for his biggest hope and biggest fear about the reforms brought in by this year’s Health Act, he said: “My main fear is that GP commissioning will lead to ever-increasing fragmentation.

“The discussions I’ve been having with commissioners in London [suggest] they’re really only concerned by things they have to face on a day to day basis.

“They’re not concerned with big strategic things that I’m concerned with – ie what is the future of cancer care, what is the future of cardiac centres?

“Clearly we have far too many people doing far too many things. There has to be a radical rationalisation of services. Which is quietly happening behind the scenes in discussions between providers.”

Sir Robert also said that he hoped CCGs would be able to define service integration and promote it.

He said integrated services could only be brought about with a fundamental change of culture. “We [acute trusts] have to effectively stop clocking up the cash register every time we put a patient in hospital – we have to be incentivised to not admit patients.”

Speaking to HSJ after the session, Sir Robert said he was “not sure CCGs will come together to form corporate organisations” capable of taking strategic decisions about services.

He also said UCLH has been swapping services with other major London providers, for example taking neurosurgery services from the Royal Free Foundation Trust in exchange for liver specialisms.

The trust is also in discussions with Barts Health Trust about sending cardiac services there in exchange for concentrating cancer services at UCLH.

Readers' comments (10)

  • Looks like an Olive branch. But the book was on the other foot for a long time.

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  • Whatever happened to Public Consultation? Is this CE exempt from the duty to consult? Private 'swapping' of services is cynically avoiding key aspects of public accountability!

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  • Public consultation is a requirement if the change is "significant" (according to the exact wording in national guidance) and one would argue that the number of patients affected is so small as to not warrant that. Providing the decision is clinically and financially sound, why spend all the time and money on an enormous exercise? The national direction of travel is for patients to be treated in larger centres because it's safer.

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  • While it's true that 'consultation' is required only for substantial changes, there is a much wider duty on all parts of the NHS to involve patients & the public on all service changes, in S242, which is often overlooked. And larger centres are better only if the evidence is there to show increased volume equates with improved outcomes, not always the case.

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  • I surprised anyone considers this CEO respected, he routinely outsources high grade clinical services to overseas companies at the expense of UK jobs, without consulting his GPs. CCGs will mean for the first time he will have to listen to the needs of UK GPs which means his vision of the NHS will lie in tatters - by Lonewolf

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  • Of course the main point of the article is that the commissioning map does create a risk of fragmentation of services which will be financially and clinically unviable in a relatively short time.

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  • Hello John, I was the previous poster - thank you for that, I've looked it up. I've also done some reading about how activity can be inversely proportional to outcome, because it's not just how much you do of X, it's the infrastructure you do it in. I've learnt 2 very useful things!

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  • "taking neurosurgery services from the Royal Free Foundation Trust in exchange for liver specialisms" isn't quite as I would have described it, having been involved as a comissioner at the time. As commissioners we ensured there was engagement in this process, with patients and OSCs.

    Good to hear UCLH admit they did ring up the cash register and they may stop.

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  • Anon 346 - Sir Robert IS widely respected, for many reasons but in my book because he is willing to take decisions such as outsourcing out of hours imaging reporting to Australia, and swapping services to create larger centres of excellence etc, all of which results in better services for patients at lower cost to taxpayer. He does this in spite of resistance from luddite medical and non medical trade unions and narrow minded groups that dont really represent patients best interests. Sadly he is in a minority in the NHS where senior posts are too often given to those who show no leadership and cling on to power and the prospect of a big pension by ensuring that nothing upsets the apple cart.

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  • I work for UCLH in a junior management position.
    I am proud of working for this Trust and the inovation we use to try and give the patient the best possible experience.

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