A radical reorganisation of hospital services in England that is vital to secure the safety of patients and the financial viability of NHS trusts is being blocked for political reasons, a leading health think-tank says today.
Too many hospitals provide too many of the same services and are chasing too few patients to maintain standards. But public concern and political opposition are "major stumbling blocks" in many reconfigurations, the King's Fund says. The NHS has to find £20bn of savings over four years, creating a "major imperative" to cut hospital capacity and provide more care in the community, it adds.
The report comes as experts insist that hospital closures are essential to improve quality and meet budget demands. Yesterday, The Independent revealed Imperial College Healthcare NHS Trust faces a £100m deficit and is considering closing St Mary's Hospital, Paddington, and moving its services to Hammersmith Hospital. The trust denied it had plans to close St Mary's.
The King's Fund's conclusions will put pressure on Andrew Lansley, the Health Secretary, who announced a moratorium on hospital closures last year. He has drawn criticism for delaying decisions on two recommended closures in London, leaving staff and patients uncertain about the future.
The report comes as the bitterly contested Health and Social Care Bill returns to the Commons amid a growing rebellion among Liberal Democrats. Critics of the Bill claim it will lead to the break-up of the NHS and are attempting to force a vote on the issue at the party conference this month.
The King's Fund calls for further changes to the NHS Bill to "depoliticise" the closure of hospitals by removing the Health Secretary's responsibility for making the final decision and passing it to an independent body.
Experts said further hospital closures were essential. Richard Thompson, president of the Royal College of Physicians, said: "There is an urgent clinical need to reconfigure acute services primarily to drive up quality, as well as to contain cost."
Peter Carter, chief executive of the Royal College of Nursing, called for an end to the taboo on hospital closures. "Some of those hospitals that we have known and loved, and which were performing appropriately in their day, are no longer appropriate," he told a meeting of the think-tank Reform.
Sir David Nicholson, the NHS chief executive, warned politicians in July that they must back big service changes or put "quality and safety at risk".
Candace Imison, deputy director of health policy at the King's Fund and author of the report, said: "Changes to the way hospital services are organised in some parts of the country are now a necessity, not an option, if the NHS is to deliver safe, high-quality care.... Politicians must grasp the nettle on this – not to do so risks allowing the continuation of poor quality and potentially unsafe services."
A Department of Health spokesperson said: "The King's Fund has highlighted that reconfigurations should be based on quality, safety and efficiency, with decisions underpinned by strong public engagement. We agree. Our plans to modernise the NHS empower local clinical commissioning groups to develop services that will best meet the needs of patients."
The Independent's story about a threat to the future of St Mary's provoked a furious reaction from Imperial College Healthcare NHS Trust. In a letter to the paper today, Mark Davis, the chief executive, says the review is looking at "patient pathways, not sites", contradicting a statement from the trust on Friday that said it was "reviewing how healthcare could be provided in the future across its sites" and "will consider how to make the best use of our buildings".
One of three sources for The Independent's report said: "The proposal being openly canvassed is that Imperial will be centred on Hammersmith Hospital, with an expanded clinical and research site, and St Mary's will close."
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