Monday, 18 February 2013

Think every hospital should survive? You need to see a doctor | Catherine Benett

Think every hospital should survive? You need to see a doctor | Catherine Benett: It is wrongheaded for MPs to claim that their local health establishments are a credit to their communities.

Inasmuch as a hospital can ever be lovable, Lewisham hospital sounds adorable. It must be, to inspire the Valentine's Day buggy protest, the marches, media assault and months of inventive, full-on campaigning that now ensure that outsiders who had never thought of Lewisham hospital until a few weeks ago are feeling jealous. Maybe some hospitals really are like the one in the Olympics ceremony, with clusters of concerned doctors, and children bouncing on vintage beds.
Might it be better, in fact, come the next hospital admission, to bypass the depressing central London establishment in which my sick friends have encountered some of the world's most truculent nursing staff and go straight to Lewisham? Here, the treatment has inspired tributes from former patients, along with chilling professional threats of what will happen if the place is downgraded, as recommended by a local health administrator: "People will die."
If the Lewisham campaign is something special, its message is echoed everywhere that patients and their politicians are fighting the full, or partial, closure of local hospitals. In Greater Manchester, for example, supporters of Trafford General, "birthplace of the NHS", cite a petition of 12,500, flawed consultation and inadequate replacement services amounting to threat to life, as well as "heritage". In Highgate, north London, campaigners are enraged by a plan to close beds and sell off property at the Whittington, the hospital in which, says the local MP David Lammy, underlining the gravity of the situation, "my two sons and I were born".
In west London, where patients and politicians are organising against closures at Charing Cross and Hammersmith hospitals, the emphasis is on collective emotion. "In our campaign to save our hospitals and A&Es, we have started vigils for everyone to come together to share their hopes by candlelight," says the campaign website, adding, possibly to mollify candle-sceptics, that in the 80s this tactic actually preserved Charing Cross.
Thus, historians who claim that the British were never a nation of slushy candlelighters until the night, in 1997, when fans mourning Princess Diana transformed Hyde Park into a twinkling shrine, may want to reconsider their chronology. "Holding candles, singing and joining hands in the spirit of hope turned the tide and saved the hospital," say Hammersmith's campaigners. "We can do it again." Supporters who can't make these mass vigils are invited to "light a candle at home to join us". And if this does not persuade Jeremy Hunt to explain how and where lost services are to be replaced, there can surely be no harm in adding a waxen effigy to the argument, or bringing a relevant curse down upon health commissioners who may have neglected to apply the four tests required by the government prior to major service reconfiguration.
Although, being a notoriously spiritual type, Hunt may be more susceptible than most health secretaries to persuasion by vigil, some campaigners have favoured a more proactive approach. When, for instance, Labour first advanced a scheme for centres of excellence, with the aim of improving survival rates, David Cameron declared war on any closures this might involve. "The government can expect a bare-knuckle fight with us over the next few weeks and months about saving district general hospitals as a key part of the local NHS," he said in 2007. "People simply do not understand why maternity units and accident and emergency units are being shut down when accident and emergency admissions are up and births are up." Poignantly, while Mr Cameron now totally gets it, "people" are still having the same old difficulty.
At least, as Heidi Alexander, the Labour MP for Lewisham East, put it last month, in a Westminster Hall debate on hospitals: "I have not known an issue to cause as much anger and concern as the proposals that are currently on the table to close the A&E department and the maternity department at Lewisham hospital."
Although Alexander has a powerful argument where Lewisham is concerned, since the withdrawal of services at this successful hospital (without adequate replacement) owes less to clinically inspired reconfiguration than to PFI-induced bankruptcy nearby, the emotional local reaction adduced in virtually every debate on hospital closures tends to make argument redundant. Which MP, of any party, ever acknowledges – in public – that public health might, as many clinicians and academics insist, be better served by a Lord Darzi-style restructuring, if only in the future, of the constituency's services? "Every single member of this house will defend their local hospital, as that is where their constituents go for treatment," the Tory MP for Croydon, Gavin Barwell, said last week.
"When they open me up," said his colleague, Tony Baldry, going one better, "they will find inscribed on my heart the words 'Keep the Horton General'." Even the layperson will appreciate that this cannot leave much room on Mr Baldry's heart for the qualifier: "Unless evidence shows that a tiered arrangement of polyclinics, urgent care centres and acute hospitals with a critical mass of senior clinicians would produce lower mortality rates."
In a country where, as Danny Boyle demonstrated, the health service has acquired iconic heritage status, up there with the royal family's, for an MP to encourage the decommissioning of a hospital is equivalent to demanding the human sacrifice of Princess Beatrice. This forced loyalty to the status quo could help explain why, when complaints came in about Mid-Staffordshire hospital, MPs were so slow to react that Robert Francis QC now suggests, mildly: "They might wish to consider how to increase their sensitivity with regard to the detection of local problems in healthcare."
The NHS medical director, Sir Bruce Keogh, recently rebuked politicians of all parties for a reflexive local boosterism, even when this conflicts with clinical needs, as well as PFI-based reconfiguration. "Unless we can get to that place where people look at the greater good which is sometimes in conflict with local interests, then professional, personal and political interests will conspire to perpetuate mediocrity and inhibit the pursuit of excellence."
Keogh, of course, will not lose his job if indignant activists begin to doubt his passion for a local building in which glowering nurse assistants occasionally throw lumps of cold mashed potato at the vulnerable and post-operative.
But with Mid-Staffs to remind everyone what the health service can sometimes be, and a fifth of doctors admitting they would not recommend their local hospital to a family member, MPs can no longer be forgiven for depicting the local hospital as invariably "much loved", "the heart of our community". When added together, all these much-loved hearts make the NHS, to quote the Lib Dem MP Stephen Lloyd, "the glue which binds our society together". To judge by the number of bits that are now dropping off, amid the unforgivable chaos of the coalition's reforms, it really is possible to love something to death. The Guardian

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