Hospitals must stop providing certain services or shut to sustain NHS – MPs

http://www.theguardian.com/society/2014/feb/12/commons-health-committee-warning-hospitals-stop-services-merge-survive

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Some hospitals must stop providing certain services or even shut altogether if the NHS is to remain viable, even though such changes are "notoriously controversial", an influential group of MPs warns today.

The Commons health select committee said in a report that a dramatic expansion of the centralisation of hospital services was needed to help the NHS cope with the increasing pressures on its budget.

In a report on the finances of the NHS and social care, the MPs say that integrating the currently separate services, which ministers and NHS leaders say is vital for the NHS to remain sustainable in the face of rising demand caused by ageing, "will also require reconfiguration".

In a recognition of the controversy such proposals generate and the pressure MPs feel under to oppose a rundown of their local hospital, the MPs say: "Advocating service integration without recognising that the consequence of integration is reconfiguration of acute services … is simply dishonest."

There is an "urgent need to increase the pace and scale of service reconfiguration in the health and care system," they add. A series of mergers between hospitals is needed but is being held up by fears that such proposals will be blocked by the Office of Fair Trading and Competition Commission, the report adds.

Although "changes [that] closure of hospitals or remove services from hospitals … are notoriously controversial with local communities", that is often because the case for them has been poorly made.

Public consent would increase if NHS leaders nationally and locally became better at explaining how rationalisation of services can improve the outcomes patients experience, which include better survival rates and fewer deaths, the MPs suggest.

NHS England, which runs the service, welcomed the MPs' findings. "The committee is right to highlight the scale of the challenge in delivering health and social care integration. The report quotes [NHS England chief executive] Sir David Nicholson making this very point to the system in October last year," said a spokeswoman.

The MPs also take the NHS to task for not pushing through "transformative change" in the way services are delivered to patients in their bid to make the £20bn of savings by 2015 required by the "Nicholson Challenge" efficiency drive.

Funding for social care, which has been slashed by many local councils in recent years despite rising need, must be ringfenced otherwise "there is a serious risk to both the quality and availability of care services to vulnerable people in the years ahead." Lack of social-care support is a major cause of bedblocking in NHS hospitals.

The NHS made £5.8bn of savings in 2011-12 and £5bn in 2012-13. But it is likely to have saved only a further £4bn by the end of next month, 15% below the target for 2013-13, the MPs found.

While much of the savings so far have come from pay restraint imposed on NHS staff, including a two-year pay freeze, that will not be enough to meet the £20bn target, they add. Jeremy Hunt, the health secretary, who has aksed the NHS pay review body to cancel the 1% rise previously promised to all NHS staff by George Osborne, because the service cannot afford it, has already accepted the committee's view on that.