Laurence Vick
Posted on 12 Sep 2013

Hospital Closures – Not Yet

Arguments are mounting for NHS reconfiguration, but the issue of hospital closures remains politically unmentionable.

The Royal College of Paediatrics and Child Health (RCPCH), in its 2013 medium-term goals audit, has found that there is as little as a 6% consultant presence on child wards at weekends, and 11% out-of-hours during the week. This stands in contrast to what the RCPCH says is good progress in other areas of child hospital care, including an improvement in working-hours consultant presence.

The initial report had recommended that the number of child units be decreased, concurrent with an increase in staff numbers. This is an issue which appears to resurface in the review, albeit in cautious phrasing: 'centralising expertise' and 'providing more care in the community' would, in context, seem to be allusions to the medical profession's increasing amenability to consolidation of units. Put bluntly, this may mean closure of hospitals or units.

Night hospital

The debate that surrounds closure of hospitals is rich with controversy, and eminently political. In her recent broadcast for Radio 4, Jackie Ashley tackled the issue of the lack of 24-hour care in the NHS, interviewing the executive director of King's College Hospital, Michael Marrinan.

Marrinan believes that only large units can provide essential round-the-clock services, and, to make this possible, hospital closures will be necessary. His view is not universally shared, particularly for the users of condemned hospitals; but it is increasingly becoming accepted that resources need to accommodate demand through radical, structural change.

Report, review, report

Reconfiguration of children's heart units, recommended after the Bristol Heart Scandal in the 1990s, is a debate still unresolved 12 years after the publication of the Kennedy Report. Reconfiguration plans were recently stalled again on the orders of the then health secretary Jeremy Hunt, and plans to end child heart surgery at Leeds General Infirmary have been quashed by a High Court Judge.

How NHS England will approach the issue in the wake of that decision remains to be seen. The drive to reduce the number of units and increase their specialisation was widely endorsed by health and medical negligence experts, as well as campaign groups and families affected by the events. A re-review of the proposals is pending.

Detractors have found much to criticise in proposals for reconfiguration and 24/7 care. There are concerns over the logistical task of keeping hospitals open at all hours, including paying for extra support staff and round-the-clock availability of equipment and resources.

However, Michal Marrinan, speaking in Jackie Ashley's programme, expressed the opinion that reconfigured 24-hour specialist care appears to be a cost-neutral solution; patients receive better treatment, spend less time in hospital and do not need to return as quickly; staff also adjust quickly to a more streamlined system. It may be some time, however, before Marrinan's experience can be more widely tested.

Follow the link below for Jackie Ashley's broadcast Night Hospital on Radio 4:

Laurence Vick and his team at Michelmores are handling a number of cases involving recent operations at Bristol Children's Hospital, as well as the Leeds General Infirmary children's heart unit, which are at the centre of the on-going debate over reconfiguration of paediatric cardiac units.

Laurence Vick was lead solicitor to the families involved in the Bristol Royal Infirmary Public Inquiry, resulting in publication of the Kennedy Report in 2001. He and his colleagues have significant experience in handling litigation concerning all aspects of paediatric and adult cardiac surgery and related treatment and diagnosis.

If you, or a member of your family, have suffered adverse consequences from cardiac surgery or related treatment please contact Michelmores' clinical negligence team for free confidential advice. Freephone 0800 0730 140.