Getting local clinicians to drive reconfiguration plans will reduce “overall system costs” and the number of letters sent to local MPs and newspapers, according to a hospital doctor leader.
Speaking at the Liberal Democrats autumn conference, British Medical Association consultants committee chair Mark Porter highlighted two “pertinent reasons” for seeking a clinical consensus to lead reconfigurations.
He said: “If evidence can be found to support it and if clinicians can be induced and trusted to agree on it, then that change will lead to the cost improvements that are necessary because the overall system costs will go down if you are seeking better care.
“That’s a really key thing to hang onto, it’s not just the immediate costs of one hospital against another, or one hospital against primary care but the overall system cost of treating patients will go down if we seek the evidence for what is best care and apply it even if that includes reconfiguration.”
Dr Porter added: “The other really important reason why it’s important to have clinical consensus leading opinion is because it will keep the postbags down.
“It will keep the postbags down for local councillors, it will keep them down for local MPs, it will keep it down for the local newspapers, and in that way the clinical consensus will lead to genuine population consensus.”
He also rejected suggestions that hospital doctors were always opposed to reconfigurations.
He said: “Of the hospitals that were around in 1948, every one has been closed or massively reconfigured since that time.
“Most of those closures and reconfigurations have happened with the support of hospital doctors and often with the rest of the clinical community as well. It is actually an untruth that doctors always try to resist change, we are often at the forefront of promoting it,” said Dr Porter.
However, too many hospital reconfigurations are cost cutting attempts “dressed up as change” which increases public cynicism and damages necessary service evolution, the leader of the Royal College of Nursing told delegates.
RCN general secretary and chief executive Peter Carter said more reconfigurations were necessary but that service changes must be clinically justified.
He highlighted the successful reconfiguration of stroke services in London, which he described as “something truly revolutionary” that was saving hundreds of lives, even though it had been initially been resisted by campaigners.
Dr Carter said: “We at the Royal College of Nursing know the way, the where and how we deliver healthcare has to change and evolve. But one of the things that constantly complicates life, is there are far too many examples of where things are dressed up as change, and wards or A&E departments are closing.
“It is not actually on the back of a good evidence based business case. It’s on some short term saving that will stack up long term problems. That is what confuses the public and embeds the cynicism.”
He added: “So yes to more change, more transparency, properly thought through business cases, a greater narrative with the public and actually a greater narrative with the politicians.
Dr Carter said there were “copious other examples”, like stroke care, of clinically justified reconfigurations.
“But what you need is the narrative, you need to get clinicians on board, you need to get it clinically led. …There’s a cynicism. You’ve got a much better chance of delivering it if it’s clinically led.”
Nuffield Trust head of policy Judith Smith also highlighted the power of language as well as public involvement and “political bravery” in justifying reconfiguration.
She described the experiences of a group of Canadian politicians, doctors and managers who had introduced service changes in the 1990s, and visited the think tank earlier this year.
Dr Smith said: “They talked a lot, it really struck me, about ‘converting’ hospitals, not closing them.
“The other powerful message was the real political courage that was there. They talked about ministers of health and their equivalent of MPs going out to hundreds of public meetings and talking to communities to make the case.”
Dr Smith was speaking at a fringe meeting in the Health Hotel at the Liberal Democrats autumn conference, run jointly by the RCN with the British Medical Association and the Nuffield Trust.
The event asked conference delegates to consider whether they would support an imaginary service reconfiguration, involving the closing of an accident and emergency unit, if they were local GPs and community nurses, hospital doctors, NHS managers, patients and MPs.