There are a lot of issues here, let me touch on a few.

Since the 70s there has been an intention to move care out of hospitals and into “community” settings. For example, in 1988 there were 80k geriatric beds in NHS hospitals, in 2009 there were 16k; over the same period the number of nursing home beds increased by 100k. (The interesting point here is that NHS hospital geriatric beds is NHS care, whereas nursing home beds are in the private sector: effectively we have privatised a large proportion of geriatric care over the last 30 years.) The move from hospitals to the community is partly for the patient’s benefit (you do not have to travel as far, it is easier to park your car, or get there by public transport, appointments are easier to change etc), but mostly because it is expected to be cheaper. If you attend a clinic in a hospital you will be seen by part of a consultant-led team, and be seen by a consultant or a qualified doctor. If you attend a clinic at a GP or community clinic you are more likely to be seen by a practice nurse. A practice nurse is much cheaper than a doctor: the clinic appointment will cost the NHS far less. (This is not a statement about nurses other than the fact that they are paid less than doctors.)

It is a simple fact that if you move care out into the community hospitals will close. This is not about withdrawing services (the services will be in the community: through GPs or community health services, often in the patient’s home). It is about using the remaining resources more effectively. It is rational to close the older hospitals, those in places where it is difficult for patients to get to, difficult to park; and move the resources to the newer, purpose built hospitals.

Labour recognised this and through the acute services review tried to determine how many hospitals were needed and how best to use resources. Cameron opposed this. He was irrational, producing a list of (IIRC 30) hospitals that he said Labour would close and campaigned to keep them open. Well, those hospitals probably should have been closed, and if they had been closed 5 years ago we probably would not have this daft “£20bn efficiency savings” drive that we are going through now. (That’s the “efficiency savings” that mean 50,000 frontline job losses.)

Cameron is a coward, he is not man enough to do the right thing. The right thing is to do a proper review, work out which hospitals are excess and close them. A top-down review, from the centre, with politicians doing their job which is to present the case of the best course of action. Instead, coward Cameron is using the “market”. He is waiting for hospitals to get into debt, go bankrupt and close. This coward’s way of doing things will produce the worst possible experience for the patient, since a hospital in the red will drastically cut costs (and give worst care) in an attempt to survive.

Let me finish with a few figures. My local PCT strategic document for the next 5 years (yes, I know it will not exist in 5 years, but the strategy is still valid) says that £70m will be moved from acute care to community care between now and 2015 (that is, in 2015 acute care budget will have £70m less than it does now; community care budget will have £70m more than now). That represents 20% of the acute care budget. Can the three hospitals in my area withstand a 20% cut in income? The answer is no. One of them will take over community health services in April (so called “vertical integration”), so it means that they can move staff from the hospital out into the community setting. This hospital will be fine, their income cut in acute care will be matched by the increase in income for community care. The other two hospitals will have a 20% cut in income. I reckon one of them will close, either directly, or indirectly by being taken over first by the third (much larger) hospital.

It would be far more honest, and statesman-like, for Cameron to do a review to determine how many hospitals we need, and which hospitals will close. Instead, coward Cameron is dithering and hiding from his responsibility.

Sad to say the header here is fairly typical of leftist spin about healthcare policy and utterly wrong headed.

Public concerns about healthcare policy should be with the quality of patient outcomes rather than with the quantity of resource inputs.

“Accidents, errors and mishaps in hospital affect as many as one in 10 in-patients, claim researchers. The report in the journal Quality and Safety in Health Care said up to half of these were preventable.

“Checks on 1,000 cases in just one hospital found examples of fatal surgical errors, infections and drug complications.”
http://news.bbc.co.uk/1/hi/health/7116711.stm

Try this from the National Audit Office:

“Hospital productivity has fallen over the last ten years. There have been significant increases in funding and hospitals have used this to deliver against national priorities, but they need to provide more leadership, management and clinical engagement to optimise the use of additional resources and deliver value for money.”
http://www.nao.org.uk/publications/1011/nhs_hospital_productivity.aspx

The government is right right about the need to reform the NHS but it hasn’t convinced many – least of all the medical profession or the LibDems at their recent Sheffield conference – that Lansley’s proposals are best prescription for doing so. Try the editorial in the BMJ in January:

Dr Lansley’s Monster
http://www.bmj.com/content/342/bmj.d408.full

@Bob B

Sad to say your response is fairly typical of rightist spin about healthcare policy and utterly wrong headed.

Public concerns about healthcare policy should be with the quality of patient outcomes rather than with the quantity of resource inputs.

“Health outcomes” are very convenient because they are so difficult to measure, and because by the time you have measured them, the policy makers will have moved on to high paid jobs in the private sector. Think about it, it takes a long time to measure outcomes – policies on statins and hypertension treatment made 5 years ago will probably only show up in comparative studies in a decade more more time. If you want to performance manage, you have to do it on something that can be measured now.

Patients demand to be treated as soon as possible, quite rightly. That is why there were targets on waiting lists, and anyone who argues against keeping waiting lists short clearly has never been a patient on a waiting list. The Tory idea of waiting lists is “you’ll get your treatment sometime, don’t know when; have a nice day”. Labour’s approach was “you are guaranteed to have the treatment within 18 weeks”. Personally I would have cut that guarantee to 8 weeks, but there just wasn’t the money to do that.

Try this from the National Audit Office:

And I raise you by giving a far more thorough study from the Centre of Health Economics at the University of York that says:

Between 1998/9 and 2003/4 there was strong input growth, particularly after 2000/1, averaging 5.5% a year. Recruitment increased … there was greater investment in equipment and buildings. Over the same period output growth lagged behind input growth. Even so, year-on-year increases in the number of patients treated meant that output growth averaged more than 3.8% per year up to 2003/4. The net effect, though, was slightly negative productivity growth between 1998/9 and 2003/4.

This has since changed. NHS output has continued to rise, but at the faster rate of 5.7% a year. Not only are more patients being treated, but the quality of the care they receive has been improving. The index of input growth suggests a slowdown in input growth since 2004/5, which has been increasing at a rate of 4.8% a year, compared to 5.5% previously. This slowdown is due to a levelling off in staff recruitment and reduced reliance on agency staff. Since 2004/5 growth in inputs has been matched or slightly exceeded by growth in outputs, so recent NHS productivity growth has been slightly positive.

It is notoriously difficult to measure “productivity” in healthcare. The NAO uses productivity on activity, York includes quality in its measurement. Cutting waiting lists costs a lot of money, and hence reduces “productivity”. (Remember: patients like short waiting lists.) Like Lansley, you appear obsessed with ephemeral “outcomes”, so why quote productivity based on activity? Perhaps you should be more consistent.

Hang on, hospitals closing is hardly a new phenomenon. As demographics and users needs change you would expect some provision of new services and the loss of services that are no longer appropriate. So the argument can only be about how to manage these changes and given that the top down method works very poorly in most areas, why should we be fighting to maintain it in healthcare?

David Cameron promised during the Election Campaign that The National Health Service would be Ring Fenced if he became Prime-Minister. Now that he is Prime-Minister he is doing the opposit to what he promised with the view to breaking up and privatising The National Health Service.

What he will now do if he cannot get is way is further starve the NHS of more money so that it becomes run down and useless and he will of cause blame everyone else for the problems that it is experiencing.

David Cameron is a deceitful lying tactician.

The sad fact is that care in the community ends up costing dearly for many elderly people who are means-tested for anything other than healthcare (another flexible concept). A short stay in hospital would include social care components such as meals, but when being treated in the community it increases social care needs which might include help with bathing and dressing, easily carried-out within a ward environment by the existing staff.
Most of this social care is now being contracted-out to private companies and each person pays separately for a visit, transferring cost to the ‘consumer’ and also creating the need for services.
And just to add another bitter pill to the plight of the elderly;- it has only been in the past few years that private nursing care has ceased to be charged, however, many thousands of pounds has been lost by individuals paying for care which others received as part of the ‘free at the point of delivery’ ethos. The tories introduced it and nulab didn’t deal with it with any expediency.
@4 That’s just about what they asserted about care in the community.

@6 “That’s just about what they asserted about care in the community.”

We’ve had a free market in ‘care in the community’? I don’t think so.

7
I believe your post @4 is making reference to the changing demographics and service need requirements not about how those services are delivered I can’t see any reference to markets
Community care was supposed to be a different way of providing care for the elderly (and other service users) giving them choice and the ability to be cared-for at home, this was followed by mass closures of hospitals. What we have now (as explained in @6) is fragmented services which are costing the elderly dearly and creating a need for much more input than was necessary in an inpatient area and charged to the individual.
Will changes made by the current encumbents do any better than the previous Thatcherites, I suspect not.