LEADING ARTICLE : Untried cure kills hospitals

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The Independent Online
The National Health Service is Britain's greatest paternalistic industry. It still operates mainly, as it always has, on the assumption that it knows what's best. Patients, temporarily infantilised by illness and largely ignorant of their conditions, generally accept on trust whatever they are given. Thus has an unhealthy culture developed in which professionals confer and patients defer. The results have been unique. No other industry could, for example, speak so unashamedly of "rationing" services to its customers.

This deferential culture is also responsible for a policy dbcle in NHS. The hospital closure programme that has been gathering pace over the past three years is now in danger of being discredited. The reason: NHS planners convinced themselves that they knew best and so failed to conduct sufficiently rigorous studies or to consult the public properly. As a result they pressed ahead with a closure programme that is now proving to be not only of doubtful merit but also politically explosive because of outraged local opposition.

There is increasing evidence of serious flaws in the assumption that British cities, notably London, have too many acute hospital beds. On the drawing board, this belief seemed to be well founded. Health economists and officials at the Department of Health agreed that technological change such as day-case surgery meant more people could be treated without long stays in hospital. The future, it seemed, lay simply in spending more money on primary health care and amalgamating hospitals so that expertise could be concentrated on one site. Statistical comparison of London with other cities in Britain and internationally seemed to make a compelling case for closing a number of hospitals.

The operation of the new NHS market only strengthened the case of frustrated planners who have long wanted greater rationalisation, particularly in London. Hospitals in the capital and other major conurbations have proved to be expensive under the market system. Closing beds seemed to make commercial sense.

Yet the new health-care managerial lite made a drastic mistake. They assumed that an intellectual consensus among themselves and the fresh dictates of the market place would be enough to force through change that the Government already agreed with.

They were wrong. The system is not working as they predicted. Despite considerable extra funding for primary health care in London, there has been an increase of nearly 25 per cent in the number of emergency admissions to hospitals over the past three years. No one seems to know why this has occurred. But the consequences are clear: as acute beds close, more patients are being admitted to already overstretched casualty departments and reducing the cash available for non-urgent treatments.

It may be that GPs are classifying more of their referrals as emergencies in order to escape budget constraints. But the problem seems to be more fundamental. Many experts now believe that increasing the provision of primary health care actually raises demand for hospital treatment because more problems are spotted.

Whatever the explanation, the uncertainty has prompted the King's Fund, a highly influential health think-tank, to call for closures to be halted until alternative services have been provided. It was the King's Fund that was primarily responsible in the first place for forging the consensus favouring closures.

Ministers should heed this call. The failures of community care have already demonstrated the dangers of closing hospitals without either recognising the consequences or organising well-funded replacement services. Until offered sound evidence to the contrary, the public will understandably regard acute hospital closures as a disease creeping through our cities rather than as the cure the planners so confidently prescribed.

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