"Every year, demand for NHS health care – mainly from the greater number of older people – increases. Over the next five years it will grow by about 20 per cent, yet financing will increase by only one per cent. This is no longer viable."The solution according to Paul Corrigan is to close hospitals. Yes. You read that correctly. The solution to 20% more old people needing more healthcare is to close hospitals - at least 40!
Dr Grumble would be the first to admit that the NHS estate needs rationalising and he would agree that the more you do of one thing the better you get at it but to imply, as Professor Corrigan does, that general hospitals should become specialist centres with one hospital doing one thing and another another is arrant nonsense.
Dr Grumble's masters used to teach him about the unifying diagnosis. The patient presents with various symptoms and signs and the key is to put them all together and find the single diagnosis that accounts for them all. It can work well. Previously fit young people who are acutely unwell are unlikely to have more than one thing wrong with them but it is not the case for the elderly.
It's no good being in a hospital that specialises in the treatment of heart disease and fancy ablation treatment for atrial fibrillation if your heart disease causes a stroke which is treated elsewhere. Or, if you are elderly and need a hip replacement, you do not really want to go to a slick privatised specialist hip replacement centre if you also have diabetes and heart failure as well as your arthritis. You need to be in a large general hospital where there is the right expertise available to cope with every contingency. You need specialist care for your hip but you may well also need specialist care for your heart and for your diabetes and any number of other possible complications. These scenarios are not unusual. In an increasingly elderly population they are the norm.
Paul Corrigan is right. Though he doesn't quite say so, the NHS estate is in a mess. The problem has remained, despite the NHS being a planned service, because politicians have always fought shy of any hospital closure. We can manage with fewer hospitals. But please lets not have small specialist hospitals with ring-fenced work. We need fewer but bigger strategically-placed hospitals with specialists doing sufficient work to do their jobs well with other specialists alongside them.
If demand is increasing by 20% over five years and financing by 1%, hospitals will have to close because there just won't be the money to pay for them. This is a financial solution forced on us by the marktet. But let's not kid ourselves that this is any sort of a solution to the clinical problems we face. What is to happen to all the increasing numbers of frail elderly people for whom there will simply be no hospital beds? Can they really be looked after in the community? Will this be any cheaper? Or does care in the community mean less care or, perhaps, no care?