Chris Ham: Care will get worse unless politicians make tough calls

The public is resistant to proposals to reduce the role of local hospitals and increase the time it takes to travel to obtain care

The NHS in many parts of the country is actively considering how to change where hospital services are provided.

London is in the eye of the storm because of the failure by successive governments to support moves to bring about improvements in care that medical experts have known were long overdue. In all parts of the capital there are opportunities to improve care by reducing duplication and ensuring that hospitals work together for the benefit of patients.

This will only happen if politicians are willing to support doctors and managers in making the necessary improvements in services. Andrew Lansley's decision to halt the changes taking place following Lord Darzi's review of healthcare in London shortly after the 2010 general election does not augur well in this regard.

Increasing financial pressures add to the urgency of finding a solution to a problem which is first and foremost about the quality of care.

Improving the quality of care for patients means taking tough and often unpopular decisions. Not every hospital can provide the full range of care, and there are strong arguments for neighbouring hospitals to work together to locate specialist services in those able to achieve the best results. This has started to happen in relation to cancer care and stroke services, and is certain to become more widespread in future.

Much more controversial are decisions about the location of maternity services and A&E departments. The public expects to have easy access to these services and is resistant to proposals to reduce the role of local hospitals and increase the time it takes to travel to obtain care. The difficulty is maintaining access when there are challenges in recruiting the staff required to deliver high-quality care 24/7.

Failure to act risks allowing the continuation of poor-quality and potentially unsafe services and could put the lives of patients at risk. A heavy responsibility rests on ministers to show the leadership that too often has been lacking in the past.

Professor Chris Ham is chief executive of the King's Fund.