www.publicinvolvement.org.uk

Could it be MAC’s prescience for hot button issues? Or maybe it’s just that the political dog days are again upon us. Whatever the reason, we could not help but notice that the subject we wrote about a year ago has come round to haunt the headlines again. We refer of course to our quick and dirty analysis in September 06 of the BBC’s online comments about why the public hates the idea of centralising hospital services and prominent fear that “people will die in the ambulance” if they have to be taken farther than their local A&E to specialised trauma centres. 

We think our comments made then deserve another airing...

Why this button stays hot

Two things have come together to touch off round two of “dying in the ambulance” fears. The first was the conclusion published in the Journal of Emergency Medicine that the risk of death went up the more miles a patient travelled for urgent care. Rather obvious one might think. But hardly innocuous, judging by the speed with which Dr David Colin Thome, National Director for Primary Care, was into the BBC studios with the retort that the Sheffield researchers had used out of date late ‘90s data and ignored big advances in paramedic and ambulance services in recent years and the virtues of specialised centres: “If you have a heart attack and you go to one of these specialist centres your outcomes as a patient are immeasurably better than if you go to a local hospital". Maybe so, but serious tabloid damage may already have been done to the case for reconfiguring local hospital services. And this coincides with new health minister Lord Darzi’s plans for his “once in a generation” national review from which recommendations for change and rationalisation are bound to emerge. And to make matters worse, this all chimed with the Conservatives’ campaign to stop the downgrading of DGHs and save local A&E services which looks set to rumble on for months to come. Comparisons may be invidious, but we also can’t forget that the new Holyrood government has made good on its popular pledge to halt the reconfiguration (aka closure) of local accident and emergency departments north of the Tweed. So it is not a propitious season to persuade local people in England to give us their A&E services.

Do we have a fetish for hospitals?

There is a certain weariness about all of this fetishising of hospital services. Back in the ‘80s Julia Cumberlege’s neighbourhood nursing review did a good job of pinning down why people were anxious about the perceived nearness of emergency services, even if they had never had to use them and why this made them reluctant to embrace new forms of care outside familiar institutions. But that anxiety keeps popping back up again. And it has done so recently because the ultimate destination of the present NHS reforms has never been clearly explained by government. That is unsettling and spurs people to cling to what they know. And it is how people perceive things, especially when they may be taken away or changed, that maters most – and influences how they vote. Dr Richard Taylor MP for Wyre Forest knows a thing or two about this. If Mr Brown should have an early election, will the “Kidderminster Effect” be seen more widely in Labour heartlands we wonder?

Florence was right about hospitals

Perhaps Labour should enlist Florence Nightingale’s help on the subject of whether we need hospitals: “My view, you know is that the ultimate destination of all nursing is the nursing of the sick in their own homes! I look to the abolition of all hospitals and workhouse infirmaries”. That is still a worthy objective and one echoed by a commentator on the debate in this week’s HSJ who said “The only clear conclusion possible now is that the boundaries of what we currently term “hospitals” will have to be flexible and open to change as new technologies and service models develop.” How true, so let us hope that local commissioners don’t lose their nerve and let the “Save our Hospital” battalions – the occasional AWOL minister amongst them - block off all avenues of change.