02 August 2013
NHS Closures: will care be better or worse? Paul Sankey discusses
Stafford’s Accident and Emergency Department has been saved (for a day time service only) and the High Court has overruled plans to reduce services at Lewisham Hospital.
The Judge’s decision was greeted with clapping in court. People like their local hospitals and see local care as better care. Small is beautiful and local is good.
Or is it? The truth is probably not so simple. Some areas of routine care are best given locally where the skills needed are not particularly specialist and journey times to hospital are short. But the evidence shows that complex care is much better when given in fewer, more specialist hospitals. We have learned that for instance from investigations into heart surgery in Bristol where it was found that children had better outcomes when treated in specialist centres. And in my work investigating why people suffer negligent medical treatment it is obvious to me that generalists doing specialist work do not do it as well as specialists.
In more specialist units staff have more training. They work in a narrow field, have more detailed knowledge and specialist equipment. They are more likely to be up to date with developments and may be able to offer treatments not available elsewhere. They are likely to have better judgment. They may even be involved in ground-breaking research. I pursue more claims arising from poor clinical judgment arising from generalists than from specialists in teaching hospitals. Knowing what can go wrong, I for one would much rather go to a teaching hospital than a district hospital for specialist care.
Decisions about closing units and specialising care are not therefore as simple as many people might think. Local, district hospitals have many benefits and we all like to feel we are being treated on our patch. But in many areas of care we need fewer more specialist unit. We have some excellent NHS hospitals. We need to make sure they are focussing on the right work and doing it well.