Supplementary evidence submitted by the
NHS Confederation (PPI 142A)
ADDITIONAL EVIDENCE FROM THE NHS CONFEDERATION
The Health Select Committee have requested examples
from the NHS Confederation of incidents where the Department of
Health or politicians have made illogical interventions at a late
stage in the process of consultations on reconfiguring services.
The NHS Confederation offers these examples to assist the Health
Select Committee in determining whether it is a reasonable expectation
that the Department of Health or politicians in the department
have the right to intervene in this way and whether it should
remain one.
EXAMPLE 1: SPECIAL
CARE BABY
UNIT
Work by the paediatricians across two hospitals
suggested that the level of medical staffing may make the service
unsafe but that it was not cost effective to increase staffing
levels because the relatively low level of low birth weight babies
would mean that there would be insufficient work to maintain their
skills. The second hospital involved had a better unit but still
required increased staffing to be safe. It was proposed that combining
the units would create an enhanced service that might have reduced
to requirement to send babies to more distant units. The research
evidence for a relationship between quality and volume of work
is often less good than many planners imply but in the case of
premature babies the evidence for a volume effect is strong.
A major problem with staffing in the SCBU led
the Trust to decide that it needed to close the SCBU and consequently
the Maternity Unit under emergency powers.
The then Secretary of State intervened to order
a review, which confirmed that the Trust was correct. The Secretary
if State then requested a second review from an independent expert.
This broadly confirmed the results of first. A third review by
a government agency made some suggestions about managing the interim
but did not lead to any substantially different conclusions. Several
months later the Unit did close but in the meantime services had
been very unsafe.
EXAMPLE 2: PROPOSAL
TO CENTRALISE
SERVICES FROM
TWO HOSPITALS
TO ONE
This involved a proposal to close two general
hospitals which were both small and beyond the end of their useful
life. The most sensible option was to site a new hospital on the
same site as a major cancer centre.
The Secretary of State at that time intervened
to change the location to a new area on the grounds that it was
socially deprived in a way that the other was not. There were
four problems with this:
— the new location was very close to
another very large teaching hospital and would have had a very
adverse affect on it;
— the business case for the new hospital
depended on retaining the flows of patients from both the hospitals,
the new location meant that this was not possible and therefore
it was not possible to create a financially viable institution;
— it is not clear that providing a
hospital was in this instance the appropriate response to deprivation.
If the issue is poor health as a result of deprivation then good
primary care is what is required; and
— the new site was in a constituency
of a government MP and the more logical option was not. This,
probably unfairly, opened the process to accusations of political
bias.
The net result of this was that the hospital
could not be built. Perversely this might not be such a bad outcome
but the process by which it has come about is less than desirable.
EXAMPLE 3: PROMISING
TO MAINTAIN
SERVICES
In this example the Secretary of State at that
time made a public commitment to maintain an A&E Department
at a hospital mid way between two other A&E Departments both
less than 10 miles away. This was against the advice of those
responsible for planning services.
Shortly after this the then Secretary of State
intervened again following a separate review to approve the building
of a PFI hospital to the east which meant that there was now under
five miles between the two A&E Departments. This rendered
the A&E at the hospital in the middle largely unviable.
NHS Confederation
6 March 2007
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