Notes from the field of public involvement

Wednesday, 06 September 2006

Why the public hates the idea of centralising hospital services

We know how valuable patient and public feedback is. We also know, as our recent conversation with Paul Hodgkin, the founder and Chief Executive of Patient Opinion shows, how hard it can be to foster and use it. His experience so far is that patient experiences are probably more positive than negative: "Interestingly from the start about 50% of our postings have been positive, 30% mixed and 20% critical and it does not seem to change much."

Of course as patients, we are also all members of the public. But this masks the fact that there is something distinctive about what 'the public' thinks about NHS issues - especially proposals for local changes to hospitals. This is more about expectations than direct or recent experiences, though the two are sometimes melded. That is why lumping it all in as 'PPI' is not very helpful. The following piece of feedback research illustrates the point that public views should not be assumed to be broadly the same as patient experiences.

Great timing

With a great sense of timing, the end of the dog days of August saw the announcement that at least 10 major hospitals in London, Surrey, Sussex, Lancashire, Greater Manchester and Cornwall would face potential closure or a downgraded role as part of a move to "centralise" NHS services. In particular, it was reported that emergency care in some places would move to regional centres. To rub salt into the wounds of those to be "downgraded", this story came hot on the heels of the announcement that other parts of the England were to benefit from a whopping £1.5bn PFI hospital building programme.

How did the public react to this news, given the strong attachment people have to their local health institutions? To find out, I analysed the feedback which the BBC invited people to make to their online reports. When all was said and done there were 306 comments up to 21st August when the online responses closed. I reviewed each one of them to see what the most common themes were.

Common threads of anger and mistrust

This is what emerged - in a rough order of priority - from some every angry comments:

  1. The cost saving argument is a sham; what is really needed is more hospital services not less
  2. Bureaucrats are too powerful and have the wrong priorities because they focus on money and not care
  3. Increasing travel times to get to A&E services will lead to more deaths and complications because care will be delayed - the 'golden hour' argument
  4. Relatives will find it a burden and more expensive to travel farther to visit people in hospital
  5. Downgrading hospital services flies in the face of people having more choice about their healthcare
  6. It is a betrayal of the NHS to close services because people have had no say in the changes

Bellwether views

Politicians should take note of these bellwether views. Parliamentary seats have been lost on passionate local concern about downgrading services. The same thing is happening over community hospitals too.

Once the 'save our A&E' placards are out, the battle lines are drawn and the time has passed to have a balanced discussion about the (undoubted) need to provide more care, including urgent care, outside of hospitals.

Amongst the 306 responses, there were rare voices pointing out that many who attend A&E could - and should - receive urgent primary care elsewhere. But they were drowned out. After all it is a brave soul who will contradict the paramedic from Durham whose comment was recommended most frequently in the whole debate: "If accident and emergency services are further rationalised then distances will increase and risks to patients will increase."

Unrealistic expectations?

Does this sample of reactions to 'centralising' hospital services show that the public really expects too much of the NHS, even at the present record high level of funding provided by Parliament? Is it symptomatic of a slough of despond about anything that changes the NHS? Or has the nation's addiction to ER, Casualty and Holby City engendered an anxiety that emergency care will be too distant when needed?

It's an intriguing question that won't go away and one which we may see being fought out at the forthcoming party conferences. If you are going to Labour's in Manchester later this month, make sure you pack your tin hat and flak jacket.

BBC News: Future of 10 Hospitals in Doubt 17 August 2006

Andrew Craig | (Problem occured connecting to database: The server requested authentication method unknown to the client