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Last Updated: Thursday, 7 December 2006, 10:17 GMT
On the ropes over hospital reform?
By Nick Triggle
Health reporter, BBC News

The great persuader, Tony Blair, entered the debate about the planned shake-up of hospitals.

He told sceptics it was about improving care not cutting services. But why does the public not believe him?

NHS protests
Thousands have protested against NHS cuts across the country

Anger over proposals to strip hospitals of key services can be traced back to 1998.

It is now eight years ago since campaigners in Kidderminster started mobilising themselves to fight cuts to their local hospital.

The fight resulted in one of the most remarkable upsets on election night in 2001 when retired physician Dr Richard Taylor took the Wyre Forest seat from Labour.

What was happening to Kidderminster Hospital in the late 1990s is now being mirrored across the country.

NHS bosses are carrying out a series of reviews which could result in A&E and other acute services such as cardiology and trauma care being taken away from hospitals and centralised in "super regional centres".

The moves have prompted thousands of people to take to the streets in signs of what could be the most prolonged unrest since the poll tax revolt in 1990.

Money

Protesters remain convinced that the changes are being introduced to save money - the NHS finished last year over 500m in deficits, forcing a wave of job cuts.

But this is despite the fact that most experts agree there is some sense in centralising expert care to ensure quality services.

So how come the government has singularly failed to convince the public of the merits of the so-called reconfiguration?

Jonathan Fielden, chairman of the British Medical Association's consultants committee, said: "The government should have been tackling this a few years ago, but were scared off by the 'Richard Taylor-effect'.

"They realised they could lose out at the polls if they tackled this so have avoided it ever since.

Politicians and doctors have not explained what they want to do so it is not surprising the public feel it is important to have access to care locally
Chris Ham, former Department of Health adviser

"It means, now that their hand is forced, they are doing it at a time when money is short so it is getting linked to that."

Dr Taylor acknowledges his victory at the 2001 election, which was repeated four years later, has had an impact.

"I think it certainly gave them food for thought. But we did not start the campaign because we object to change.

"It is perfectly understandable to transfer complex care to regional sites. People are happy with that if it is about brain surgery or trauma treatment.

"What they don't want to see - and what happened at Kidderminster and is now in danger of being repeated - is a wholesale scrapping of all acute services such as A&E. It is really down to the government's approach."

But others believe the government's problem has been caused by a lack of presentation, rather than a fault with policy.

Ambulance

Chris Ham, a former Department of Health adviser and professor of health policy at Birmingham University, said the public have been let down because the issue has not been properly explained.

"In the public mind a hospital is a hospital. They do not understand why they need to be driven past the local hospital in an ambulance.

"Politicians and doctors have not explained what they want to do, so it is not surprising the public feel it is important to have access to care locally."

However, he believes ministers have now realised they need to change tack.

Leaked minutes of a meeting involving ministers last week showed Ms Hewitt acknowledging the government needed to be "smarter about communications".

LOST OPPORTUNITIES?
May 1997 - On the back of the feel good factor of Labour's election victory, ministers could have put the case for hospital reform which had been discussed within NHS circles since the 1970s
July 2000 - The NHS Plan set out a vision for the next 10 years, but the government decided to focus on driving down waiting lists
April 2004 - New system of funding, called Payment by Results, starts to be rolled out, meaning hospitals were going to have to be more efficient and, therefore, some scaling down was inevitable
January 2005 - White paper proposes shifting care out of hospitals and into the community, which many pointed out would lead to some centralisation of care

The government has, until this week, kept to the line that it is up to local NHS managers to decide on reconfiguration.

And this is despite the fact that officials close to Ms Hewitt briefed journalists over the summer about the impending reforms.

But Wednesday marked the start of a charm offensive in a bid to convince the pubic the merits of the reforms.

Senior doctors were wheeled out to press the case, and Tony Blair intervened, using his legendary powers of persuasion to try to swing the debate in the government's favour.

It was noticeable that both ministers and their advisers spent the day saying doctors had to get involved in the debate, with emergency care tsar Sir George Alberti admitting politicians were not trusted enough.

But when asked why the government has entered the fray so late, health minister Andy Burnham could only deny the accusation, although he conceded others may judge otherwise.

None of this, however, can disguise the fact that the government has spurned a number of opportunities to open the debate - the 10-year NHS Plan was published in 2000 followed by a series of key reforms that many predicted were leading towards a major shake up.

Roy Lilley, a former NHS trust chairman who now writes and broadcasts on health issues, said: "The government lacked the political courage to kick start the debate.

"This is long overdue, it makes both financial and clinical sense. But the problem is that the debate is out of government hands now and they are going to struggle to get control of it."




SEE ALSO
Setting out the case for change
05 Dec 06 |  Health

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