Closing one in three hospitals would improve patient care – leading doctor: Centralisation of NHS services would put more doctors in one place, says Professor Tim Evans of Royal College of Physicians
Shutting a third of hospitals would improve quality of care and should be part of changes to the NHS that would let patients see their GP or have surgery at the weekend, a leading doctor has claimed.
A dramatic centralisation of services would benefit patients by putting larger numbers of doctors in fewer places, with the inconvenience for the sick and their loved ones of having to travel further outweighed by better treatment, according to Professor Tim Evans of the Royal College of Physicians (RCP).
Evans is the spokesman for the Future Hospital Commission inquiry into how healthcare should evolve to cope with demographic and financial challenges. It is being run by the RCP, which represents hospital doctors.
Speaking to the Guardian, Evans said that concentrating services in fewer hospitals would help the NHS "move from being a five-day health service to a seven-day health service" offering a full range of services for 12 hours a day every day of the week.
The current set-up, in which most non-urgent hospital services operate only on weekdays and rarely beyond teatime on those days was unacceptable.
"You've got seven-day working in Marks & Spencer or John Lewis, but you can't have it in a hospital or general practice. There should be a seven-day health service, absolutely unquestionably," said Evans, the RCP's previous vice-president.
"At the moment we have a five-day service, with an emergency service at weekends."
Hospitals should routinely offer services such as surgery, diagnostic tests and laboratory services on Saturdays and Sundays. GPs surgeries should also open to see patients unavailable during the week, argued Evans.
The current working pattern, he said, "means that half your plants are sitting there idle. Hospitals are working at maybe 20% capacity on the weekends. Why is that?"
Such a big shift in NHS practice could be achieved if there were "significantly fewer hospitals".
Referring to ongoing work by the RCP and Academy of Medical Royal Colleges on how many hospitals will be needed in the future, Evans added: "If the modelling showed that we could only have two-thirds of those then I would say 'Well, I'm afraid that's the case'."
The alternative, he said, was sticking with close to the existing number of hospitals but patients being disadvantaged because not all would have a stroke or heart attack unit, for example.
The inferior quality of much weekend care compared with that available Monday to Friday, a 10% higher risk of a patient dying if they are admitted over the weekend and a lack of senior doctors on duty on Saturday and Sundays were also reasons for pressing ahead with the changes, Evans added.
Medical leaders have been arguing for slimming down the NHS's supply of certain types of hospital units, such as A&E or maternity units, or shutting some entire hospitals. But Evans's suggestions are by far the most radical yet.
The NHS Confederation, which represents hospitals, welcomed Evans's remarks. "The NHS desperately needs to radically reshape the way it plans and organises care to meet the needs of patients as well as keep the service financially sustainable.
"Senior clinicians have sometimes been reluctant to step forward. But we need them to help make the case as they are so trusted by the public," said Mike Farrar, its chief executive.
But health services delivered closer to or in people's homes needed to be expanded to enable hospital care to contract, and decisions on reshaping hospital services in an area could not be "imposed on communities", he added.
Dr Clare Gerada, chair of the Royal College of GPs, dismissed Evans's ideas. Offering hospital services seven days a week "will siphon off much-needed money into the creation of new medical and administrative teams of people in hospitals and away from where it's really needed, on things such as more day centres, respite care for carers looking after the long-term ill, befriending services and care home beds," she said.
GPs' surgeries could not open any more than they do, typically 8am to 6pm or 7pm on weekdays, because there were not enough family doctors to staff them.
A spokesman for the Department of Health said it was for the NHS, not ministers, to decide such issues. "Changes to local health services are decided locally – local healthcare organisations, doctors, nurses and other health professionals are best placed to decide what they need."
The spokesman welcomed the concept of greater access and higher standards of care. "Patients should get the same level of service on a Saturday or Sunday as they do on a Wednesday.
"This would mean better care and we are already working with professional associations to drive this forward across the NHS," he added. The Guardian
Shutting a third of hospitals would improve quality of care and should be part of changes to the NHS that would let patients see their GP or have surgery at the weekend, a leading doctor has claimed.
A dramatic centralisation of services would benefit patients by putting larger numbers of doctors in fewer places, with the inconvenience for the sick and their loved ones of having to travel further outweighed by better treatment, according to Professor Tim Evans of the Royal College of Physicians (RCP).
Evans is the spokesman for the Future Hospital Commission inquiry into how healthcare should evolve to cope with demographic and financial challenges. It is being run by the RCP, which represents hospital doctors.
Speaking to the Guardian, Evans said that concentrating services in fewer hospitals would help the NHS "move from being a five-day health service to a seven-day health service" offering a full range of services for 12 hours a day every day of the week.
The current set-up, in which most non-urgent hospital services operate only on weekdays and rarely beyond teatime on those days was unacceptable.
"You've got seven-day working in Marks & Spencer or John Lewis, but you can't have it in a hospital or general practice. There should be a seven-day health service, absolutely unquestionably," said Evans, the RCP's previous vice-president.
"At the moment we have a five-day service, with an emergency service at weekends."
Hospitals should routinely offer services such as surgery, diagnostic tests and laboratory services on Saturdays and Sundays. GPs surgeries should also open to see patients unavailable during the week, argued Evans.
The current working pattern, he said, "means that half your plants are sitting there idle. Hospitals are working at maybe 20% capacity on the weekends. Why is that?"
Such a big shift in NHS practice could be achieved if there were "significantly fewer hospitals".
Referring to ongoing work by the RCP and Academy of Medical Royal Colleges on how many hospitals will be needed in the future, Evans added: "If the modelling showed that we could only have two-thirds of those then I would say 'Well, I'm afraid that's the case'."
The alternative, he said, was sticking with close to the existing number of hospitals but patients being disadvantaged because not all would have a stroke or heart attack unit, for example.
The inferior quality of much weekend care compared with that available Monday to Friday, a 10% higher risk of a patient dying if they are admitted over the weekend and a lack of senior doctors on duty on Saturday and Sundays were also reasons for pressing ahead with the changes, Evans added.
Medical leaders have been arguing for slimming down the NHS's supply of certain types of hospital units, such as A&E or maternity units, or shutting some entire hospitals. But Evans's suggestions are by far the most radical yet.
The NHS Confederation, which represents hospitals, welcomed Evans's remarks. "The NHS desperately needs to radically reshape the way it plans and organises care to meet the needs of patients as well as keep the service financially sustainable.
"Senior clinicians have sometimes been reluctant to step forward. But we need them to help make the case as they are so trusted by the public," said Mike Farrar, its chief executive.
But health services delivered closer to or in people's homes needed to be expanded to enable hospital care to contract, and decisions on reshaping hospital services in an area could not be "imposed on communities", he added.
Dr Clare Gerada, chair of the Royal College of GPs, dismissed Evans's ideas. Offering hospital services seven days a week "will siphon off much-needed money into the creation of new medical and administrative teams of people in hospitals and away from where it's really needed, on things such as more day centres, respite care for carers looking after the long-term ill, befriending services and care home beds," she said.
GPs' surgeries could not open any more than they do, typically 8am to 6pm or 7pm on weekdays, because there were not enough family doctors to staff them.
A spokesman for the Department of Health said it was for the NHS, not ministers, to decide such issues. "Changes to local health services are decided locally – local healthcare organisations, doctors, nurses and other health professionals are best placed to decide what they need."
The spokesman welcomed the concept of greater access and higher standards of care. "Patients should get the same level of service on a Saturday or Sunday as they do on a Wednesday.
"This would mean better care and we are already working with professional associations to drive this forward across the NHS," he added. The Guardian
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