Would you go further for better healthcare?

VIEWPOINT John Black President, Royal College of Surgeons of England

Your chances of survival are greater if you are taken to a specialist hospital

John Black, president of the Royal College of Surgeons of England, says too often decisions which are vital for improving healthcare are being 'fudged' by politicians.

He says they seem to prefer an average service provided in their constituency rather than an excellent one further away.

District general hospitals throughout the country are rightly viewed with great affection, loyalty and are a source of comfort to us all.

But what if I were to tell you that for some conditions, for example, you were involved in a major traffic accident or were diagnosed with a rare form of cancer, your chances of survival could be much greater if we instead had doctors organised in fewer specialist regional centres?

'Better Service'

What is best, a convenient service on the doorstep or a better service that requires more of a journey?

The pressure to try and supply everything through local hospitals risks wrong decisions or poor compromises being made on the basis of short-term populism

Any steps to look at, let alone implement, amalgamation or relocation of NHS services, almost invariably lead to a vigorous campaign of resistance by the local community.

Such campaigns are often successful, for example the loss of the labour seat of Kidderminster to the independent Dr Richard Taylor.

But the fact remains that it is becoming increasingly impossible, due to specialisation in surgery, to provide everything that modern healthcare can offer in every single hospital in the country.

There are neither the numbers of specialists nor adequate facilities and equipment, to achieve this.

'Pressure'

The pressure to try and supply everything through local hospitals risks wrong decisions or poor compromises being made on the basis of short-term populism rather than the long-term benefit of patients.

Too often, decisions which are vital for improving our health service are being fudged by politicians who sometimes seem to prefer an average service provided in their constituency rather than an excellent one a further 30 minutes away.

NHS planners face a difficult task with a largely historical distribution of hospitals, advances in medical technology, an ageing population, dwindling resources and a forthcoming general election.

If hospital reorganisation is to gain public confidence these decisions to close some services must be clearly explained, consistently applied, transparent and made on a national basis Read your comments

This is why the Royal College of Surgeons, in its new manifesto Surgery in Safe Hands, calls for a planned restructure of the NHS that includes local and national networks and the development of specialist centres where appropriate.

Hospital services should be as close to the patient as possible.

This is an underlying principle of the NHS and should not be disturbed without reason.

But where there is clear evidence that lives will be saved services should be centralised to larger more distant units.

In addition advancing technology and increasing complexity will inevitably be concentrated in selected hospitals as only by doing this can surgeons gain adequate experience to produce the best results.

'Public confidence'

If hospital reorganisation is to gain public confidence these decisions to close some services must be clearly explained, consistently applied, transparent and made on a national basis so no area of the country is left isolated.

Politicians and planners should also remember that ultimately the choice lies with patients.

All clinicians will have come across patients who are not prepared to travel to have certain treatments, even if that treatment will without doubt increase their chances of survival.

This is true patient choice, and must not be disregarded.

The challenge is to make this dilemma as rare as possible.

In recent years it has seemed an easier political decision to simply offer 'Hobson's choice' within an ageing and obsolete structure of local hospitals (each straining every sinew to supply the full range of healthcare) than to make proper long-term national decisions about how we provide patients with the best.