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Nicholson warns of need for more NHS centralisation


The outgoing head of the NHS has said hospitals will have to close and services centralised to improve patient care.

Sir David Nicholson called for a radical reorganisation of health services so a smaller number of larger hospitals offer most major surgery while smaller hospitals scale back the care they provide.

In an article in the Daily Telegraph, he warned that the NHS could face a £30bn funding shortfall in just seven years unless it changes the way it provides services.

He called on politicians from all parties to back the controversial reforms, which he fears otherwise could be used to score party political points in the run up to the next general election.

Sir David, head of NHS England, told the paper: “I believe the NHS needs to embark on a programme of transformational change to front-line care, arguably the most significant since its creation.”

He said the service was “fragmented and confusing” for patients and did not always provide the best possible care for the sick. And he warned that the NHS simply could not afford to delay the proposed changes

He said: “Like every major health system in the world, we face a big financial problem for the future: the sums don’t add up. If we don’t change, we face a funding gap that could be £30bn by 2021.

“We know that centralised, large units, with concentrated expertise and technology, work best in providing the most effective care.

“So we need to ensure this approach is applied to other parts of the health service, for people with very rare conditions, and for significant planned surgery.”

Without sweeping change, services will not be sustainable, he said, adding: “Our NHS does a superb job for millions of people, day in day out, but it cannot stand still – it needs to adapt to survive.”

Last year NHS England published proposals calling for the centralisation of major hospital services.

And over the next few months it is due to set out its plans for changes for specialist services, and proposals to ensure GPs provide more services serving larger populations.

The proposals have sparked controversy with fears that many towns will be stripped of their emergency facilities.

But Sir David insisted the changes are crucial to improve the welfare of patients.

He wrote: “The NHS proposals for change always come with controversy.

“Too often the overall public interest gets lost in a debate about winners and losers with too much focus on buildings and not enough on services.

“This time I hope the NHS, the public, policy makers and politicians will join forces to make it happen. As someone who has spent 30 years working in the NHS, I know it matters too much to get it wrong.”

He also called for the NHS to do more to “listen to patients and act on their concerns” and make full use of technology to ensure the public is “fully empowered and included in all aspects of the NHS”.

Sir David will retire next month after a year in which he has been heavily criticised over his part in the Mid Staffordshire Hospital Trust scandal.

He was in charge of the health authority supervising Stafford Hospital for two years before being appointed NHS chief executive in 2007.


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Readers' comments (3)

  • tinkerbell

    take your big golden handshake from the nhs Nicholson and fcough, parasite.

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  • Parasitic he may well be, but he's absolutely right about the need centralise specialities and about the £Bn's shortfall that's coming down the line.

    The NHS has to drastically retrench and to savagely cut the services it offers otherwise more and more parts will end up failing which will lead to more private provider involvement.

    The NHS is an old bird now and the way she's going I doubt she'll see in her 70th birthday - I think there's a good chance she'll have a massive coronary if she doesn't start drastically cutting down and looking after herself!

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  • tinkerbell

    He will retire next month after a year in which he has been heavily criticised, following the inquiry into the Mid Staffs scandal, for his previous role as a senior official supervising the area.

    Moving services farther and further afield does not save lives. Why is he so concerned about saving lives now when he allowed such criminal neglect in his previous role.

    I agree with specialist services and centres of excellence wholeheartedly but I do not agree that this needs to be at the cost of local service cutbacks.

    In a trauma situation there is a window of opportunity within a time frame and the further away a hospital is can make all the difference. A nearer hospital might be able to stabilise a patient until they can then be moved on to a specialist hospital.

    Nicholson, fool me once shame on you, fool me twice shame on me.

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