We all know that just about every announcement of any change in NHS provision will be met by fierce opposition from local politicians, even from local politicians that have responsibility for the policy that leads to the change! That is a problem, but it is fair to say that the NHS in general has been hopeless at building the case even for sensible changes.
Whilst some in the NHS appear to be unaware of it, there is a lengthy and exhaustive process which is supposed to be used before there is any significant reconfiguration of services. There are even a few examples of this working well, although the lessons are that the process takes years not months, it starts from a neutral position not a drive to save money, and it needs genuine engagement with stakeholders over a long period not a short tick box “consultation” exercise.
In summary the process requires engagement during the generation of options and at least 12 weeks consultation on any proposals, with an expectation of serious external evaluation of responses. It requires a formal review of the clinical merits by the National Clinical Advisory Team; and a Gateway review of the plans for management of the changes. Throughout the process the relevant Health Overview and Scrutiny function maintains an oversight and can ultimately force any proposals to the Independent Reconfiguration Panel which advises the Secretary of State.
Despite a required process (first set out in 2007) there are still examples of very poorly managed attempts to push through changes which claim to be clinically necessary but become highly controversial closures. Worse still the “no closures” attitude is so entrenched in the public mind that there are “save our hospital” campaigns before the hospital is even threatened – pre-emptive retaliation.
Given these problems then the use of the failure regime has advantages. It removes the need for extensive consultation and for the formal reviews, it opts out the formal reconfiguration process. It dilutes any requirement for consultation and removes the oversight by Health Overview and Scrutiny Ccommittees. It sets out a tight and fixed timetable so issues can be forced along.
But best of all it provides a hate figure, the Trust Special Administrator, who can be blamed for anything unpleasant. Sure, the SoS has to make the final decision but under the Hunt/Lansley hands off approach they will say they have to follow the advice provided – the “not me guv” defence which they think will work – but won’t.
With the variations on a theme that the Health & Social Care Act 2012 the method can be deployed to stop local protest getting in the way of orderly rationalisation of NHS services. So long as you pick the right Trust Special Administrator then you get the solution you want and guess who picks the Trust Special Administrator? The Trust Special Administrators are likely to be drawn from the same pool that have advised and overseen previous major projects. But we also know that the record with NHS senior managers telling people what they should do almost always a) contradict other worthy initiatives b) have severe unintended consequences and c) assume no planning is needed – shouting is enough.
So to South London (SLHT) and the recommendations of the Trust Special Administrator which are currently being “consulted” upon. Frankly the report is a mess. There are generally sensible (bleeding obvious?) recommendations to deal with the financial failure of SLHT (write off debt, subsidise over expensive PFI contracts, sell off underused estate, break up hand management of bits over to more competent managers). But for reasons unknown the report also sets out proposals to wreck the generally successful Lewisham Healthcare Trust which unluckily sits just over the border.
What Lewisham ever did to provoke this attack is unclear, except that last time a reconfiguration scheme proposed shutting their A&E they not only fought off the closure they got investment into improving the threatened facilities – maybe old scores to settle.
Anyway just how axing the A&E at Lewisham, downgrading its maternity care, destabilising its plans for local integration helps the finances of SLHT is beyond me. But it does allow the easy charge that Lewisham with only a piffling PFI is sacrificed to save two hospitals with big PFIs.
If the sensible proposals relating directly to SLHT were set out properly and the three hospitals making up SLHT were each transferred to local NHS bodies then maybe there is a solution that could get a consensus behind it. It does of course fly in the face of the rush to merge, since it reverses a previous failed merger. It leaves the best in the NHS to manage and turn around the failing parts, which is not a bad idea.
So yet again we have sensible plans likely to be scuppered by incompetent management of the change process.
So again let’s take to the streets and man the barricades to stop a daft and unnecessary attack on Lewisham.
What we really need is a failure regime for failed NHS senior management who somehow go from dominant dictatorial imposition of their ideas to being distant uninvolved and in no way accountable.
Save Lewisham Hospital.