Specialist hospitals have urged NHS England to re-think its “one-size-fits-all” approach to centralising specialised acute services because it puts their independence at risk.

Their plea is the latest sign of the fierce opposition faced by NHS England’s plans for reform from some of the country’s leading medics and most prestigious institutions.

In a report showing that many specialist hospitals have superior clinical and patient experience outcomes, the Federation of Specialist Hospitals had urged greater consideration of networks or “chains” of services instead of consolidation into between 15 and 30 centres as proposed.

Moorfields Eye Hospital Foundation Trust has a success rate of 98 per cent for drainage tube surgery for the treatment of intractable glaucoma compared with 80 per cent at some other non-specialist providers, for example.

“If the NHS is serious about improving outcomes then we need to preserve the hospitals that have the best outcomes,” Dr John Brookes, its clinical lead for glaucoma said.

Specialist hospitals fear that NHS England’s proposals would make them easy targets for taken over by larger providers. All 19 standalone NHS specialist hospitals in England, have turnovers of less than £250m, regarded as small in acute hospital terms. Fourteen have turnovers of less than £100m.

Federation chair professor Tim Briggs told HSJ that some specialist hospitals had fared badly when joining larger organisations.

“A one-size-fits-all approach is not going to work. Single speciality hospitals provide brilliant outcomes. We have got to learn from them, not dismantle, close or destroy them,” he said.

“Big hospitals can become impersonal. [At specialist hospitals] there is lots of pride in the job, everybody knows each other and people will go the extra yard for you.”

The provision of acute specialised services is under review by the 10 NHS England local area teams responsible for commissioning them.

Their work will feed into NHS England’s five-year strategy for specialised services, due to be published later this year.

New NHS England chief executive Simon Stevens suggested a greater openness to less centralised models of delivery for specialised services at the health committee last week.

He told MPs it “may not be a question of merging or closing” smaller hospitals if “creative” ways could be found to make them sustainable.

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