Sir: In today's Independent the Secretary of State for Health is quoted ("Bottomley gets mauling over hospital cuts", 6 April) as saying that "to allow the services to fossilise is not going to address the real needs". Quite so.
Why then the continued and rising outcry about change? The simple answer is that the strength of feeling in London is rooted in the daily experience of patients who are not getting the care they need, because the scale and pace of change are undermining service delivery. Older people especially will be asking themselves why they are so unimportant compared with an apparently immutable plan which has their well-being as one of its declared aims.
The proportion of frail elderly people in London is rising. They are uniquely dependent on a balance of provision between hospital care and primary and community services. There is evidence of a significant rise in hospital admissions for elderly patients, accompanied by an equally significant drop in the average length of stay. Whatever the reasons for these changes, one conclusion is clear: primary and community services are the key to the continuing health care of older people.
There are indications that packages of care arranged for elderly patients discharged from hospital are becoming vulnerable to breakdown. This is but one symptom of the stresses affecting services and patients in the capital.
Few informed observers have questioned the need for health services reform in London, though many have challenged its basis. Most have repeatedly stressed the absolute need for the management of change to be geared to the needs of patients. It is bitterly disappointing to know that this message has yet to be heard.
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