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Hunt has fudged the Lewisham question

The birth of CCGs, due in two months’ time, is suffering severe complications due to the Government’s decision to downgrade an A&E ward and remove maternity services.

As Pulse has reported, the clinical members of a Lewisham CCG are considering their position because of what they see an undue outside influence on the configuration of services in their area. This is no longer a local issue – it has questioned the whole ethos of clinical commissioning.

The issue centres on the failed South London Healthcare NHS Trust. A trust special administrator – the first of its type – was called in to troubleshoot. However, in so doing, he also reviewed the services at non-failing Lewisham hospital, calling for the A&E to close and be replaced with an urgent care centre that could handle 50% of the current patients.

On the surface, Mr Hunt rejected this recommendation. However, his announcement seems to be a case of fudging at best, out-and-out politicking at worst. The A&E will remain open, but at reduced capacity. It will only treat urgent cases, and not emergencies such as high-risk pregnancies. It will treat 75% of the cases it currently treats. Which, to the uninitiated, sounds more like an urgent care centre than an A&E department – albeit, one that admits patients.

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The health secretary argues that reconfiguration needs to happen and that money used to service debt in the NHS should be spent on patient care.

But the fundamental point is that local GPs, led by the CCG, were unanimous in their protests that this would harm clinical outcomes. The chair of the CCG, Dr Helen Tattersfield, even claimed that the whole process ‘threatened the whole ethos of clinical commissioning’.

It is apparent that the Government has failed one of the tests set by former health secretary Andrew Lansley - the architect of the reforms to put clinicians in charge of health services, lest we forget - for hospital reconfiguration: that the proposals have the backing of the commissioners involved.

In this case, the Government subtly changed this test.  Mr Hunt asked Sir Bruce Keogh, the NHS Commissioning Board medical director, to see whether there had been ‘significant clinical input into the process’. He said the TSA had passed this test - all six CCGs in the area sat on an advisory group.

However, this seems a very low threshold. As CCG chair Dr Helen Tattersfield has pointed out, this group had no voting power. And a cursory glance of the CCGs’ submissions showed that not one CCG gave the proposal its full backing.

If this is a template for future reconfiguration – that CCGs simply have to be consulted, rather than integral to the final decision – then it will affect all GPs.

Many will also see it as a signal that financial, rather than clinical, outcomes are the main priority for reconfiguration plans. Or at least that local GPs are not seen as the ultimate authority on what are the clinical needs of their local populations.

All of which can be justified, with the nation having limited resources. But it does undermine the idea that the Government’s NHS reforms put clinicians in charge.