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'Close hospitals' to save the NHS, warn managers, doctors and patients

The NHS faces financial ruin and is no longer sustainable in its current form, doctors, managers and patients warned.

Hospitals may have to be closed and major changes to the way the health service is run should be brought in to help pull it back from the brink of collapse.

The Academy of Royal Colleges, the NHS Confederation and patient group National Voices have urged politicians to “show more courage” in dealing with the NHS’s multi-billion pound deficit.

The alliance has set out a series of recommendations to rescue the crisis-hit service, including a major transfer of services away from hospitals and into the community, an increase in the number of GP surgeries and health centres and greater investment in district nursing and social care.

Mike Farrar, chief executive of the NHS Confederation, which represents health service managers, said the NHS would otherwise “descend into a vicious spiral of poorly planned, reactive responses resulting in unsustainable demand”.

But he warned that the revolution needed would be “like changing the engine while the car is still running”.

He said: “We simply cannot continue as we are at the moment. The problems in A&E will get worse and waiting lists for treatment will get longer.

“Emergency work has to take priority over planned work, which earns more income for hospitals. So more hospitals will find themselves in financial difficulty.”

Mr Farrar warned that the NHS in England was likely to be underfunded to the tune of £54bn by 2022.

He referred to a report from the Royal College of Nursing, which suggested that up to 6,000 beds - the equivalent of 20 hospitals - could be lost in an effort to make the NHS sustainable.

He said the proposed restructuring would mean fewer hospitals but more specialists on regular duty, improving the quality of care.

“Communities do feel strongly about their hospitals,” he said. “But they also feel a strong bond with their GP surgeries, and people love district nurses. What I am not saying is that care will disappear from the community.

“Most people would agree if I said I could spend some of this money to help you to live independently in your own home for longer. It is up to all of us to make the case.”

He added: “It is really important that politicians take stewardship of £110bn of taxpayers’ money every year. But we are asking for politicians to show more courage.”

Jeremy Taylor, chief executive of National Voices, said: “Patients are not best served by the current pattern of services. For the safest, highest quality care, hospitals need to be organised differently and more services are needed closer to people’s homes.

“But the changes needed are often highly controversial. The NHS has often failed to make a good case; to involve patients and communities in ways that would build trust and to follow through to ensure that the new pattern of services is better than the old.

“And the public are rightly suspicious of closures and downgrades that seem to be more to do with money than quality of care.”

 

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Readers' comments (17)

  • Quite easy to sort all this mess out: immediately review the GP contracts and mandate them to provide 24/7 care to their list. GP surgery's should be open until late everyday including at weekends. Each GP surgery would have to provide their own out of hours service too. Increase the GP budgets if necessary. If patients knew that they could see their GP that day, then they wouldn't be flocking to A&E.

    The NHS does far too much: it needs to seriously curtail what it offers. I don't think the NHS should be providing fertility treatment, gender realignment, breast reductions or any other unnecessary surgery or procedures.

    Some might think this harsh, but there's not an infinite amount of money and I for one do not want to pay any extra tax.

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  • Anonymous | 5-Jun-2013 12:42 pm

    I couldn't agree with you more on every point.

    I think GPs should also be NHS employees and an integral part of the service. their work obviously needs reorganisation so that they provide an out of hours emergency service although I suppose they are just gate keeping for A&E and genuine emergencies will end up there any way but at least they can serve the purpose of calling A&E to better coordinate care of their patient.

    I think it is time this archaic and paternalistic gate keeping practice, almost unique to the UK and not recognised by any continental European countries, should cease. GPs are good for some things but not all and just severely delay the process for many of accessing specialist care.

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  • A&E should be accidents and emergencies only, the clue is in the name.
    Hospitals should be for sick people only or for those needing operations.
    GPs should be open 7 days a week with evening opening hours, they should all offer minor procedures, blood tests etc.
    There should be more community hospital services (whatever happened to those super clinics that never appeared).
    Perhaps there should be an end to free prescriptions for some people, I object to paying over 7 pounds for a few pills whilst others who are far richer than me get stacks of pills for nothing, half of which they probably don't bother take or don't really need.
    Perhaps it is also time that hospitals offered a decent 7 day service for routine scans, xrays, pharmacy, etc. etc. so that patients are routinely discharged in the afternoons and at weekends.
    With regards the above comments, I agree to some extent that the NHS offers far too much. It is not a bottomless pit of money.
    No-one will have the courage to ration any treatment.

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  • Anonymous | 5-Jun-2013 1:27 pm

    I don't believe treatment for the sick and injured should ever be rationed but I don't believe in the NHS paying for treatments which are not related to either of these conditions and which are non-essential such as those mentioned in the first post.

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  • tinkerbell

    http://www.guardian.co.uk/healthcare-network/2013/jun/05/nhs-eradicate-bullying?CMP=&et_cid=37263&et_rid=5247757&Linkid=transforming+the+NHS+in+England

    Some of the very managers, morons, that lead the NHS into this mess are now saying they will be the ones to lead us out of this mess. Madness!

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  • tinkerbell | 5-Jun-2013 4:40 pm

    seems like pure logic to me!

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  • care for the sick and injured should not be rationed, I agree with that, what about those who are no longer sick and no longer injured?

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  • But if we close the hospitals then we MUST have more staff in the community and re-arrange the services to encompass all of the pt needs

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  • tinkerbell

    if there's no mention of this headline on question time tonight i will start to think there is some definite censorship and corruption going on at the bbc.

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  • So in other words we need to go back in time to when Gps were responsible for their patients 7 days a week, and community hospitals existed.

    yes well I do remember those days, but for some reason it was decided that was no longer the way to run the NHS, and those services disappeared. Now we will spend a fortune reorganising it all again.

    Can someone please make up their minds once and for all!!!

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  • It was the Labour government who revised GP working hours contracts and the result has been ridiculous! Of course, GP s should be open for longer and provide better access. Also, care in the community has to improve . Lots of hospital beds are filled with people who should and could be treated in their own homes. I do not understand why this is still being debated and there is no action.

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  • Sarah Brooklyn | 7-Jun-2013 1:07 pm

    Utopia! but it doesn't fit in with the cheap is best, one size fits all, general management supermarket, utilitarian style of modern healthcare.

    excellent comment Sarah.

    I re-echo that it is time for somebody to make up their minds for good and for all but I fear the existing formless model is here to stay and will continue to be tampered with until everybody can be shoe horned into the one size, and tough luck for the all the rest!

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  • I agree that care should be transferred back to the community with GP's hours being extended to accommodate this. But the funds have to be there to accommodate this, especially for an improved number of Community Nurses. At the moment, in most areas there are insufficient, and this results in a severely stretched community service and Community Nurses being overworked, which could then result to the patients having to be sent back to acute hospitals for more acute treatments. All community nurses will have to be trained in the administration of IVs and cannulation so that cellulitis can be treated , so releasing acute beds.
    Most community nurses at present have plenty of extra training including, continence assessment, wound assessment and care, the IV training as mentioned above, pressure bandaging and even nurse prescribing. All these extra skills however are not recognised in their pay! Many care for palliative and terminally ill, with the extra training required, especially in the care and use of the Hickman line.

    If care in the community increases, these factors have to be taken into account with increase in pay being one of them. The community nurse does not always have the back up of hospital to fall back on, yet is often on a lower pay band of Agenda for Change than those with less responsibilities in the acute sector. This needs to change!

    Well that's the end of my rant, as you can guess I am a community nurse and work 24 hours in the community, thus having all these extra responsibilities with little recognition (apart from the patients themselves).

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  • Anonymous | 7-Jun-2013 4:02 pm

    all your skills may not be recognised and rewarded as they should but they would soon be noticed if they were withdrawn. the problem is, if the gap is allowed to get too wide, it would take a very long time to replace care with these skills and would inevitable put further pressure on other services or cause further suffering.

    all the progress that has been made in the NHS over recent decades is being lost and will take a very long time to recover and advance any further which is such a tragedy for patients and for staff.

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  • tinkerbell

    please visit 38 degrees website to save our A&E's. Hunt to be taken to court if we can raise enough money and awareness.

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  • tinkerbell

    https://secure.38degrees.org.uk/page/contribute/lewisham-fundraiser#petition

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  • tinkerbell

    http://www.savelewishamhospital.com/wp-content/uploads/2013/03/Grounds-for-SLH-challenge.pdf

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