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In healthcare, local doesn’t always mean best

  • Comments (4)

Whenever NHS services are reorganised to offer specialist services in centres of excellence there tends to be a public outcry about the loss of local services, with accusations that the reorganisation is an attempt to cut spending. Local MPs vociferously defend those on their patch – often when the reorganisation is the result of their own party’s policies.

It’s great, therefore, to see the effect of such a reorganisation on stroke care in London.

According to a study published in BMJ, the creation of specialist stroke units and hyperacute stroke units offering quicker intervention and intensive rehabilitation is saving an average of 100 lives a year in the capital and cutting the average length of admissions.

In Manchester, public opposition led to compromise arrangements whereby no hospitals stopped providing stroke care, and only patients presenting within four hours of the onset of symptoms receive hyperacute stroke care. The study found no reduction in mortality, although length of hospital stay was reduced; the researchers estimate that if Manchester had adopted the same approach as London, around 50 lives a year would have been saved.

What’s more, the reconfiguration in London was undertaken at strategic health authority level and took account of the fact that older people tend to live in the suburbs, so the eight specialist centres were spread widely to ensure they were as close to patients as possible.

Although it is too early to say how it has affected morbidity, the study results suggest the rest of the NHS should move to adopt the London model. Perhaps this example can also be used to illustrate to worried members of the public that sometimes, closing beloved local services is the only way to ensure patients get the specialist care they need.

  • Comments (4)

Readers' comments (4)

  • Anonymous

    Indeed, but then there are countless more examples where loss of local care has lead to far poorer service for patients, and difficulties for professionals when trying to work with these services. As ever, one size does not fit all, and proper evidence (and review) is needed.

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  • Anonymous

    I think the public is generally ( rightfully) cynical of descriptions along the lines of "excellence" or "rationalisation". Remember "care in the community"? What do you think happens to an area when it's A and E gets "rationalised"?

    If you concentrate specialist services in another location, it means something, somewhere has been closed down. It means a contraction of service, even if there is an improvement in skill at the new location.

    The public has to be convinced it is not being hoodwinked. I think it's right to be highly suspicious of any health authority initiative. I think cynicism should be the default position.

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  • Anonymous

    true, but there are high costs and difficulties in reaching more distant facilities for some and especially those reliant on public transport which is poorly organised and costly in many areas. it may waste a considerable amount of patients time and more important their physical and mental resources when they are vulnerable and feeling unwell. not great travelling on trains and buses for the immunocompromised.

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  • michael stone

    I seem to remember hearing something about this concentration of stroke services, not working so well (or perhaps having negative consequences) in some more rural situations. London isn't necessarily representative, in terms of distances etc (so, travelling times), to everywhere else in the country.

    And a major problem, is sorting out whether the motive for closures really is improved outcomes, or whether a cover of 'claimed improved outcomes' is being used when the real motivation is indeed to save some money.

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