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Leading doctors say NHS cuts could save money and lives

By Gareth Iacobucci

Closures of A&E units and other hospital services brought about by savage NHS cuts could save money and actually improve patient care, according to a group of leading doctors.

In a letter published in the Guardian, leading doctors from the Academy of Medical Royal Colleges, including RCGP chair Professor Steve Field, argued that such cuts should not be immediately condemned because of their unpopularity with patients, and claimed rationalising secondary care services and shifting more services into primary care would improve standards and save lives.

The doctors said they were concerned that politicians were skirting around the issue in the run-up to the general election, and urged whoever forms the next Government to be brave in making decisions about reconfiguring services, and not to ‘defend the status quo'.

The provocative letter follows huge debate over a raft of A&E and hospital closures across the country, and came as health secretary Andy Burnham intervened to veto the proposed closure of an A&E unit at the Whittington Hospital in North London.

But the nine leading doctors argue that aggregating some secondary care into larger buildings would improve the quality of care, and also called for more services to be shifted into primary care and GP settings.

The letter says: ‘Patients may indeed have to travel further for some specialist care, but if it is significantly better care then we believe that centralisation is justified.'

‘However, there is also strong evidence to support a large amount of more routine care, currently taking place in hospitals, being carried out closer to where patients live in the community with GPs playing a crucial role in the delivery of services.

It adds: ‘Delivering this requires strong leadership and brave decision-making from doctors, managers and politicians. Simply condemning change as bad and defending the status quo as ideal is not serving the interests of patients.'

‘If the NHS is to cope with the financial pressures it is going to face under any government without resorting to indiscriminate and damaging service and staffing cuts, large-scale planned service redesign and reconfiguration based on clinical evidence will have to be at the heart of the strategy.'

NHS cuts could save money and actually improve patient care, according to leading doctors NHS cuts could save money and actually improve patient care, according to leading doctors The letter in full

This is the most closely contested general election for more than a decade and health is one of the top priorities for voters and politicians. While we welcome the focus on the NHS (Report, 27 April), we are concerned that the political debate and its attendant media coverage tend to overlook the cogent arguments for service change that will bring long-term benefits for patients.

There has been a wealth of clinical evidence for many years that specialist clinical services, such as stroke, trauma and heart surgery, should be concentrated in fewer centres. This would allow the latest equipment to be sited with a critical mass of expert clinicians who regularly manage these challenging clinical problems, and are backed by the most up-to-date research. The greater volumes of patients mean doctors are better at spotting problems and treating them quickly. Survival and recovery rates would improve markedly with many lives saved. As techniques and technology have developed over recent years, speciality rather than proximity has become the key for patient safety. So increased patient safety and improved care must be the major drivers of any reconfiguration.

Patients may indeed have to travel further for some specialist care, but if it is significantly better care then we believe that centralisation is justified. However, at the same time there is also strong evidence to support a large amount of more routine care, currently taking place in hospitals, being carried out closer to where patients live in the community with GPs playing a crucial role in the delivery of services.

Delivering this requires strong leadership and brave decision-making from doctors, managers and politicians. Simply condemning change as bad and defending the status quo as ideal is not serving the interests of patients.

If the NHS is to cope with the financial pressures it is going to face under any government without resorting to indiscriminate and damaging service and staffing cuts, large-scale planned service redesign and reconfiguration based on clinical evidence will have to be at the heart of the strategy. This may mean, for example, A&Es, children's departments and surgical units at their local hospital either closing or providing a different type of service.

Such a process can significantly improve patient care. But if it is to be managed well and properly provide the highest quality care in the best clinical environment, it must directly involve doctors, other healthcare staff and the public. This involvement should include a voice in the planning and strategy development for such services, thereby ensuring appropriate service reconfiguration driven by clinical evidence and not simply the need for financial savings.

Professor Neil Douglas, Academy of Medical Royal Colleges
Professor Ian Gilmore, Royal College of Physicians
Professor Steve Field, Royal College General Practitioners
Professor Hugo-Mascie-Taylor, NHS Confederation
Professor Sabaratnam Arulkumaran, Royal College of Obstetricians and Gynaecologists
Professor Terrence Stephenson, Royal College of Paediatrics & Child Health
Professor Dinesh Bhugra, Royal College of Psychiatrists
Dr Peter Nightingale, Royal College of Anaesthetists
Dr Neil Dewhurst, Royal College of Physicians
Professor Andy Adam, President, Royal College of Radiologists
John Lee, Royal College of Ophthalmologists
Professor Alan Maryon Davis, Faculty of Public Health Medicine
Dr Richard Tiner, Faculty of Pharmaceutical Medicine Professor David Coggon, Faculty of Occupational Health

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