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Are our NHS hospitals at risk of closure?

Lord Crisp, a former chief executive of the NHS (2000-2006) and now a crossbencher in the House of Lords, has recently identified the excessive number of hospitals in England as an urgent issue – saying that hospitals will have to be closed.  He believes there will have to be more money spent on treating patients, especially older ones, at home.

And, as the government’s Health and Social Care Bill is debated in Parliament, others have made similar warnings about the need for hospital closures – either to help meet the £20 billion of savings the NHS has to make or as a direct result of the changes to commissioning in the government’s health service reorganisation.

How might this affect the Marlborough area?  In an interview with Marlborough News Online, Lord Crisp emphasised that deciding whether a hospital should be closed “is a local issue and it depends on what sort of mix of services you have in your area. In any case, there’s no one size fits all solution.”

“Sometimes NHS planning – as with some other policy areas – is too focused on London” which has thirty major hospitals. And often the oversupply of hospital beds can be resolved by amalgamations and changes to the balance of services.

One of the main needs with an ageing population is to see “How much you can keep people at home and treat them there.”  And this must involve changing how the budget is spent – too much spent on major hospitals can mean too little spent on mobile services treating people in their homes.

As Lord Crisp made clear: older people need to be kept out of hospital where they can quickly lose functions and then, once no longer sick, need residential care.

Although he does not know in detail about Wiltshire’s balance of services, it is clear from all he told Marlborough News Online that Lord Crisp would approve of the GWH managing Wiltshire’s community health services with its successful ‘neighbourhood team’ programme which does treat people in their homes.

On the broader issues of the coalition government’s Health and Social Care Bill which is being debated in the House of Commons this week, Lord Crisp said that ‘one of the big sticking points’ was the decision to do away with the Health Secretary’s duty to provide a health service to all.

Although Lord Crisp has in the past called for greater separation between the health service and the secretary of state, “Doing away with the ‘duty to provide’ is not the same thing at all.”

He is worried “the whole thing will degenerate into an insurance contract as opposed to the present social contract – it’ll be more of a commercial contract.  And we don’t want to be looking at the small print of an insurance policy all the time. There needs to be someone in the cabinet to ensure a health service is provided for all.”

One of the major problems Lord Crisp sees with the government’s Bill is the potential conflict of interest for doctors when they are directly involved in both commissioning and providing services.  “More than that, there’ll be a public perception of a potential conflict of interest – you don’t just have to be clean, you have to look as though you’re clean.”

How will the Bill fare in Parliament?  “It depends on the LibDems.” Lord Crisp thinks the political deal has been done and it will pass the Commons. The most likely outcome is that the Lords will press some ‘significant amendments’.

[This month Lord Crisp has published 24 Hours to Save the NHS – the Chief Executive’s account of reform 2000 to 2006 (OUP)]

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