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.

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