We must resist the drift to conservatism and support the case for radical changes in NHS hospitals
As a political stream that sees itself as radical, one problem for the left is that in some areas of political change its first instinct is to conserve the status quo. For example, the left’s initial politics when it comes to the NHS is to conserve it as it is and define all change as in some way ‘reactionary’ or, even worse, as ‘cuts’.
Medicine is one of the faster-changing aspects of our 21st century society. As a leftwing progressive, it is difficult to see any of the major advances in healthcare as anything but unremittingly beneficial for individuals and society alike.
In 2006, the progress that had been made in treating the disease meant the majority of people who had cancer in the UK survived for five years after contracting it. In 2010 my 70-year-old friend left hospital the next day after a knee replacement. Ten years earlier, his other knee operation meant he stayed in hospital for 10 days. This drop in the length of stay is partly caused by the changes in anaesthetic over the last 20 years.
Both of these medical advances are progress for our society. But the political problem is these two changes in medicine – and so very many others – are making the way in which we organise our NHS hospitals obsolete.
If the length of stay after operations falls to one-third of what it was
20 years ago, why do we need so many beds in the hospital? The answer is we don’t. If patients can have their chemotherapy in their own home, why do we need so many outpatient departments in NHS hospitals? The answer is we don’t.
But if someone suggests closing four wards in the local district general hospital or diminishing cancer care in the hospital, what will the progressive stance be? It is quite possible that it will be against these changes because they are ‘cutting’ the hospital.
The title and the argument in our new pamphlet, The Hospital is Dead, Long Live the Hospital, try to challenge what appears to be a dilemma between the necessity for change and the politics of conservatism that resist change in our hospitals.
Over the next 20 years every single NHS hospital is going to have to change very radically, most of them several times. At its conservative worst the left can try and resist that and end up stopping medical progress getting to the very population we claim to serve.
Alternatively, it can recognise that in every location where NHS healthcare is delivered at the moment, some form of healthcare will be needed in the future. But to keep up with medicine it will be different and will develop a different offer to the public. It will not be possible to help bring about these improvements by conserving the status quo.
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Paul Corrigan was a health adviser to the Labour government. The Hospital is Dead, Long Live the Hospital: Sustainable English NHS Hospitals in the Modern World by Paul Corrigan and Caroline Mitchell is published by Reform
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Hi Paul! I really like the way describe the updates of NHS hospitals. I’m glad NHS is trying there best to enhance the facility of the hospitals. I wish them all the best. See you soon.
could always try bed sharing. one propped up at top and one at bottom. lack of beds in the problem. go have a look at people being treated on trolleys. hospital bed management is total nightmare for staff and patients.
So which is better, sending a team of two consultants and two specialised nurses (aka my pain management team) out to each patient who needs their six day course in pain management individually, or having a dozen of us do the course together in one centralized location? (With the added bonus of meeting people experiencing the same issues and all the opportunities for learning and mutual support that brings). Decentralization and efficiency rarely go hand in hand.
“In 2010 my 70-year-old friend left hospital the next day after a knee replacement. Ten years earlier, his other knee operation meant he stayed in hospital for 10 days. This drop in the length of stay is partly caused by the changes in anaesthetic over the last 20 years.”
Great, but three weeks ago, my 60 year old friend was sent home after keyhole surgery kidney stones after one day and was then at home for days, bleeding, being sick and passing out until an ambulance had to be called to take him back in again – and this happened 3 times!!!
I was sent home immediately after an endoscopy in which the sedative didn’t kick in till AFTER the procedure (because they were too rushed to wait for it to start working) – I was so completely doped up I couldn’t walk, they didn’t even get me a wheelchair – my relative had to go and find one for me
The level of post-op or procedure care is appalling now. Yes, ten years ago people were kept in hospital for 7-10 days – partly because they need to be. Patients needs are not now addressed, it is only cost and space which is considered.
And what about long-term illnesses where people need ongoing care?
An interesting one, this.
Centralising services in fewer, more specialised centres seems to be generally backed up by evidence. The trade-off is that they are less accessible for visitors – but for life-saving procedures an obvious choice (more sub-specialism, larger teams so better consultant cover, critical mass of uncommon procedures etc.). And it represents more efficient use of resources.
The other side of the argument about “the death of hospitals” (for which read DGHs) is more commonly-used services closer to home – more acute care from community locations, hospital outreach in GP surgeries, dialysis in clinics etc.. This tends to be strongly supported by patients and the public, as it is more convenient.
I have seen far less evidence that it is more cost-effective or represents better value-for-money, however, and wonder how rigorous and objective the financial models are supporting these ideas.
The problem of public acceptance of reform or change in the Health Service may be one of presentation.
Changes are usually presented by government or officials as a management matter, involving cost reduction or a reduction in the facilities available (the top-down approach), rather than as a matter of how the patient gets better, more accessible care and/or treatment more effectively and more quickly (the bottom-up approach).
I would like to add that the proper care of patients should be paramount and, in my view, the correct approach to health care is the bottom-up one. Saving money should be a by-product of change, not a driver of change.
Furthermore, although the NHS may take up less of British GDP than healthcare in other countries, it is quite possible that the British public has been misled by successive governments as to what a fully effective health service ought to cost on a properly calculated basis (which includes the additional costs to patients and their relatives of not having full facilities locally).
This is not surprising in the light of the drive from government, especially the previous one, to reduce income tax (a top down measure) as a be-all and end-all of policy.
As things stand, the contract culture and the heavy outsourcing already in place puts fear, into the hearts of the patients and the public at large, that changes are steps on the way to full privatisation.
The public needs reassurance on this and it will need a much greater effort in the presentation of policy. It is clear, whatever David Cameron might say, that the Tory drive is towards full privatisation. Labour needs to differentiate itself from that approach.