Chris Lancelot on… the closure of hospitals

Sixty secondary care hospitals and departments have been earmarked for ‘reconfiguration' by David Nicholson, the new chief executive of the NHS, because they are too small and inefficient. Apparently the future is in big hospitals and mega-clinics: these will develop greater expertise through serving a bigger population over a wider area.

Local casualty departments may close once major trauma is handled in large centres of excellence; maternity units might be amalgamated so 24-hour consultant cover is available. Other specialist departments are also under threat.

It sounds brilliant from a purely medical point of view, but has the government thought through the wider implications? The plan might work in a metropolitan area with comprehensive public transport: attending a cardiology department a further three miles away may not be a particular burden.

But spare a thought for the large proportion of the population which lives in towns and villages. What happens when their local hospital is stripped of core departments, or even closed entirely? Getting to A&E in the next town will not be easy, especially at night and particularly by public transport.

Even worse, how does a pensioner living in a village outside one town travel to a hospital on the far side of the next town for a 9am outpatient appointment? He will have to go into the first town, then across it, then the 20 miles to the second town, through it, and out to the hospital on its far side.

This will be difficult enough by car during the rush hour, but utterly impossible for 9am using public transport. What about the changes in infrastructure needed to sustain all the extra car journeys: the new roads, the additional parking spaces and all those extra-long journeys by ambulance and hospital transport? Has anyone considered the cost to the economy of working patients’ time wasted on travelling?

Closing hospitals in the shires is madness. It will impose an intolerable burden of cost and travel stress on the old, the sick and the infirm — precisely those who use hospitals the most — as well as clogging up the roads and inconveniencing almost everyone.

Can this really be better healthcare?

- Dr Lancelot is a GP from Lancashire. Email him at GPcolumnists@haymarket.com

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