Fragmentation: the NHS Bill offers the opposite

Yesterday I highlighted some of the claims that this Health Bill will cause fragmentation of the NHS. The irony is that it actually offers the opposite if clinicians show the necessary leadership: a chance for a more holistic approach for the care of health conditions; a more complete and consistent approach between neighbouring GPs; and the coming together of experts to offer centres of specialised excellence. For instance:

• GPs in their consortia will finally have the authority to encourage and steward their colleagues through peer review, raising standards, asking for accountability from the outliers. The variation of care in some areas has been shocking.
• More mature relationships between community and acute sector staff will be encouraged through the development of integrated pathways and creating a package of care around the whole patient rather than individual treatments. A joined-up approach is essential if we are going to achieve truly patient-centred care.
• There will finally be an impetus for specialists to band together in NHS Trusts where they can treat the volume of patients necessary to ensure that the treatment delivered is as safe as possible.

The latter is a major challenge to doctors and politicians alike. It will mean small units undertaking few operations will close and both clinicians and the local MP will have to communicate the truth that whilst there is much that local, community care can deliver, you really should be seen by an experienced surgeon for your operation. Value in healthcare has to be about patient outcomes and Dr Phil Hammond’s 20 year campaign to shut small units is based on evidence. Children died in Bristol and Oxford because their heart surgery was undertaken by inexperienced doctors. Your mother is much more likely to have a poor outcome if her hip is replaced by someone who only does one a week. What’s more important – having a local hospital or being able to walk after your operation? Chances of success need to trump the lure of convenience.

Smart hospitals are already delivering community care and they should badge their cars, bags and staff with the brand of the Hospital Trust. One of the cultural changes we need is the way we perceive hospital care: it needs to change to it usually coming to us rather than us going to them. After all, ‘hospital’ comes from the Latin “hospes” which refers to either a visitor or the host who receives the visitor. It’s about the service, not the building.