Later this summer one of the most explosive consultations on the NHS in modern times will be launched as up to 3 out of 7 hospitals serving North West London face the closure of their Accident and Emergency units. Expect fireworks as plans are set out for the future of hospital services, against a backdrop of the worse squeeze on NHS spending ever seen. St Mary's, the Chelsea and Westminster, Hammersmith and Charing Cross hospitals will all be in the mix- and at least one, possibly 2 of these will end up without ‘ blue light' Accident and Emergency units, which will mean becoming very different types of hospital.
As is so often the case, the story behind this is complex. Although the number of people attending Accident and Emergency units has been rising sharply, by no means all are doing so because of severe or traumatic illness or injury, and it would be far better to be able to treat some of these patients GP led clinics instead. The future of health care lies in improving community based care for older people and patients with chronic conditions, with a smaller number of highly specialist units for emergencies that give people suffering strokes, heart attacks or serious injuries much better chances of survival.
The problem is that the improved community services- NHS and local authority provided- should be visible and delivering results before lots of hospitals start shutting their Accident and Emergency units down. And yet what have we seen from Westminster council this last year? Social care slashed, Taxicards taken from frail elderly and disabled people, and the Centre for Independent Living in Bayswater closed. So enthusiastically have Westminster hacked away at provision for older and disabled people that they have cut by £4.4 million MORE than originally budgeted! None of this gives any grounds for confidence that Accident and Emergency unit closures will be offset by the quality early-intervention services which could prevent, or at least reduce the demand from, people needing emergency admissions. If the government expects public support for these changes- some of which may be necessary and justifiable in principle- they must show they understand and can respond to the very real concerns patients and families have about the level and quality of the alternatives available. Public support for hospitals is not based on sentiment alone. It reflects a genuine fear that warm words and promises count for less that hard evidence of a better alternative.