Surgeons call for halving of specialist hospitals

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Surgeons' leaders called yesterday for a programme of hospital closures and reorganisation to concentrate surgical expertise and minimise risks to patients.

The Senate of Surgery of Great Britain and Ireland, which represents the Royal Colleges of Surgeons and their specialist associations, said the number of hospitals providing advanced surgery should be halved to ensure that patients had access to a full range of specialists and the highest standard of care.

The move comes a day after Frank Dobson, the Secretary of State for Health, announced that hospitals would have to close and health and local authorities would have to work together to provide care closer to people's homes.

There is a growing consensus among ministers, doctors and National Health Service managers, that the NHS must adapt to survive, with specialist services concentrated in fewer hospitals while routine treatments are delivered by GP clinics and health centres. Yesterday, the Government invited applications for the first 20 pilot schemes for GP commissioning of local health services which are intended as an alternative to GP fundholding.

A report issued by the Senate of Surgery says surgical units in acute hospitals should serve populations of 500,000 people, about twice the present average. This is the minimum size necessary to allow all surgical specialties to be provided and to make the best use of expensive technology.

"In large cities ... this service might all be provided on one site whilst in parts of the country with smaller or more diffuse populations, organisational rearrangements could be made between the existing hospitals," the report says.

Charles Collins, consultant surgeon at Taunton and Somerset hospital and chief author of the report, said increasing specialisation in surgery and the expense of high-tech equipment meant small hospitals were no longer able to provide the same standard of care as larger ones.

Mr Collins said: "The problem for the small hospital is that they won't have enough surgeons to offer all the specialist skills ... Where there are two hospitals a few miles apart serving populations of 250,000 each we would recommend concentrating all emergency and acute services on one site, where all the facilities are."

In some cities - such as London, where the Royal London hospital has taken over the emergency work from St Bartholomew's and St Thomas's is to do the same for Guy's - change has already begun. Mr Collins added: "It might be ideal to halve the number of hospitals but we are alert to the political implications."

Earlier this month, the British Medical Association signalled for the first time that a limited programme of hospital closures could improve efficiency. A study commissioned by the BMA suggested that in a part of the country served by 10 NHS trusts all with accident and emergency departments, two might be closed and the number of A&E departments halved.