Hospitals will close in the name of choice says Reid

Hospitals will be allowedto close if patients choose to go elsewhere for non-emergency surgery, John Reid, the health secretary, said yesterday.
If the creation of extra capacity left the National Health Service with underused wards and theatres, or if it paid privately run centres for operations that patients did not take up, that was a "price worth paying" for the benefits of choice, said Mr Reid.
"For 60 years [since the NHS was founded] the power in health in this country has lain with the providers," he said. "I am going to transfer power to the patients."
Everyone, he said, wanted the "best hospital in the world at the end of their street". But the way to get that was to allow patients the choice to go elsewhere, with competition producing better local services.
Asked if that might not lead hospitals to close, he said: "The patients will decide that. I am not going to force people to take a third rate service. Patients will get the choice because for 60 years they have had to take it or leave it."
Mr Reid said there would be a series of steps before a hospital closed, ranging from assistance to replacement of the chief executive and management team. "If all that fails and local people still say the quality of the hospital is so bad . . . amI going to say 'no, you are forced to go to that hospital?'"
Asked if politicians were prepared to face up to that and let a hospital close, he said: "This politician is."
Challenged by reports that some NHS-run treatment centres were already running half-empty as capacity expanded, with hospitals facing deficits as a result, he said: "Even if they are haemorrhaging £5m, that is out of £50bn [the NHS budget] and it is worth it to give patients this degree of choice."
He was equally prepared to see operating slots go unused in the independently run treatment centres, for which the NHS is committed to pay under the current contracts. Patients would not be forced to use the independent centres, he said, but providing them with choice would drive improvements.
His comments came as he released figures showing the use of extra NHS facilities and independently run mobile operating centres had cut the wait for cataracts so that no one was waiting more than three months for an operation, with most patients treated within six weeks.
In Oxford and Bristol, he claimed, independent treatment centres had cut waits for more serious operations as the easier cases were transferred to them.
His stance, however, brought warnings from the NHS Confederation that hospital services were inter-related. Patients would only have a choice over non-emergency surgery. "But if patient choice closes the orthopaedic department, that would have a knock-on effect on its ability to do trauma surgery which means the accident and emergency department could go as a result," said Nigel Edwards, the confederation's policy director.
"That may not be what patients want," he said. "The secretary of state's bullish approach to closure may be entirely appropriate for a day surgery unit or free-standing centre. It might not be so appropriate if it means closing the accident and emergency department in a large town."
James Johnson, chairman of council of the British Medical Association, said: "There is much more at stake here than the secretary of state seems to acknowledge." If hospitals closed, NHS capacity would decrease, he said, and patients would lose more than surgical beds. "Where will they get the round-the-clock care, the intensive care beds, and where will doctors and nurses be trained?"

Published by the Financial Times on 3rd February 2005
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