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Could NHS re-organisation lead to improving standards?

View profile for Tom Mooney
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NHS England has recently warned that by 2020-21 the gap between rising costs and the budget for hospital and GP care could reach £30billion.

By the end of the year, NHS England will publish a document giving some indication of the scale of reform needed. It also expects most of the new local Clinical Commissioning Groups to come forward with more detailed plans for meeting the financial challenge as it is clear that urgent decisions about reorganising hospital and GP care need to be taken.

The organisation's chief executive, Sir David Nicholson, has stated: "It's a really stark choice for us, do we go for service change, change in the way we deliver services to patients or do we sleepwalk into a position where we reduce the quality for patients?

"If we don't tackle these issues now and over the next couple of years - the future for many of our organisations is facing those very dangers that Mid Staffordshire faced during the years it was involved in this terrible tragedy."

Professor Chris Ham, Chief Executive of the Kings Fund, also agrees that the need for fundamental change is pressing: "This time politicians and policymakers must deliver. This means having the courage to transform services, rather than making further bureaucratic and structural changes."

Historically, hospital changes have been very controversial in communities across England. For example, in Stafford, despite very public criticism of the local hospital, tens of thousands of people took to the streets to object to plans to downgrade some services.

On the face of it, reform resulting in services being concentrated in fewer hospitals could cause further outcry. However, to defend proposed changes Sir David highlights the stroke services in London where 31 hospitals used to provide stroke care, with the city having some of the worst outcomes for patients. Services are now concentrated in eight hospitals - and outcomes are some of the best in Europe. It is therefore my opinion that proposed reform could lead to both savings and an improvement in standards.

By Tom Mooney associate solicitor in the clinical negligence department