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Last Updated: Friday, 18 August 2006, 05:35 GMT 06:35 UK
The shape of health care to come
By Nick Triggle
BBC News health reporter

Some of England's major hospitals are likely to see services cut as part of a series of reviews being carried out. What is the future for NHS care?

Hospital campaigners on a march in Worthing
Sussex is just one of the areas under review

Pensioner George Beer was among hundreds of people who took to the streets earlier this month.

He was part of a protest against potential closures of services at the local Worthing and Southlands hospital.

The hospital is one of 15 in Surrey and Sussex which is being reviewed by local health bosses.

No decisions have been taken, but the process is likely to lead to a reduction in the number of acute hospitals.

Worthing, with its close proximity to Brighton's major hospitals, is thought to be one of the most vulnerable.

'Fear'

Mr Beer, 77, from nearby Sompting and a representative of the British Cardiac Patients Association, suffered a heart attack 12 years ago.

"My fear, if cuts are made, is that for someone who has a heart attack they will face a long trip to Brighton.

"The journey can take three quarters of an hour. That is too long for someone who needs help quickly.

"We have to do all we can to keep the hospital running with its excellent cardiac department."

This view is echoed in other parts of the country. BBC News has identified several areas where hospitals face an uncertain future, with almost all plans facing some form of local opposition.

People are increasingly being treated for long-term conditions and with good management these can be handled by GPs, nurses and other health professionals working outside hospitals
Caroline Hopper, primary care trust official

Chris Ham, professor of health policy at Birmingham University and a former Department of Health adviser, said: "This is the battle the government and NHS faces.

"The public is extremely attached to local hospitals and is not about to let go.

"But in many cases, I think change is inevitable. We do too much care in hospitals.

"There are good clinical reasons to increase care in the community."

Caroline Hopper, a primary care trust official involved in the Surrey and Sussex review process, agreed.

"What we are trying to is to change how care is provided.

"People are increasingly being treated for long-term conditions and with good management these can be handled by GPs, nurses and other health professionals working outside hospitals."

Statistics support the argument.

Currently about 30% of people in the UK have a long-term condition, such as heart disease, diabetes and asthma, and this is likely to increase as the population ages.

Community

People with long-term conditions account for around 60% of acute hospital bed days, but doctors believe with better care many of these people would never need to be admitted to hospital.

The government set out a vision in January to provide more and better care in the community.

Ministers said GPs should set up specialist clinics to help treat and manage patients' long-term conditions.

Hospital consultants were also encouraged to set up clinics in the community, while multi-purpose local health centres could carry out minor surgery and care more associated with smaller hospitals.

The problem is that they want to push ahead with changes before they have good enough community facilities in place to cope
Bob Lacey, Tory councillor

A Department of Health spokesman said: "Patients say it's a better service and it also means better value for money as the same procedure in primary care can be a third of the cost of one in secondary care."

For more complex care, such as emergency surgery and specialist cardiac care, the government believes a smaller number of large, regional hospitals will provide better services than those on offer in traditional district general hospitals.

The most recent announcement about PFI funding illustrates the point. Some £1.5bn is being spent on strengthening A&E and cancer services at a number of large, specialist hospitals.

Meanwhile, more cash is being handed over to community services and away from hospital budgets in coming years.

However, concerns remain.

Bob Lacey, a Tory councillor on East Sussex County Council and chairman of a committee set up to scrutinise the changes being made in Surrey and Sussex, does not believe the infrastructure is yet in place to support a major reorganisation of services.

"The problem is that they want to push ahead with changes before they have good enough community facilities in place to cope."




SEE ALSO
Doubts over future of hospitals
18 Aug 06 |  Health
Q&A: Hospitals under threat
18 Aug 06 |  Health

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