Hospital reconfiguration
November 2006
The BMA's position, on hospital reconfigurations is to support evidence-based changes that would improve the quality of patient care but any service reconfiguration must be properly planned and should involve the views of local health professionals and patients. Reconfiguration to suit political needs or decisions based solely on cost would be completely unacceptable.
The BMA is committed to enhancing high quality patient care and, where necessary, would support evidence-based changes that would make it easier for doctors to improve the quality and efficiency of care for patients.
It is right that there is public debate about the way our health services are delivered in the future, but any reconfiguration of services, if that is what is needed, must be properly planned and should involve the views of local health professionals and patients. Reconfiguration to suit political needs or decisions based solely on cost would be completely unacceptable. Above all, we must ensure that patients have a say on how best to deliver health services in local communities.
The way healthcare is delivered is changing all the time. There are new techniques and treatments, which mean that patients can receive their care in different ways, and new European laws regulating the number of hours that doctors can work. However, there is currently a deep level of scepticism about NHS reforms and a growing suspicion that all aspects of the current review of service provision are based on financial pressures rather than real evidence. Indeed many doctors and patients are gravely concerned that standards and quality are potentially at risk where the process is not handled correctly.
Large hospitals have a wide range of specialist services to ensure patients with the most complex needs have access to the best possible care. However, it is becoming more difficult for smaller hospitals to provide a comparable range of comprehensive services. It therefore makes sense to review the range of services available in each hospital serving particular geographical areas.
There are real fears that closing an A&E department will lead to other services being taken away, eventually leading to a complete hospital closure. This must not be allowed to happen. Smaller hospitals could continue to provide facilities for patients with minor injuries, carry out planned surgery and deliver intermediate care. While the larger hospitals, with a full-range of specialist services, can deal with the more seriously ill patients.
Communication on and involvement with the decision-making process must improve to help overcome professional and public concerns. One other key change needed is to do far more to encourage and facilitate clinical leadership of safe, evidence-based, necessary reconfiguration at a local level, in particular to involve clinicians in reconfiguration decisions in partnership with the public.