In Saturday’s Western Mail, Matt Withers turned his attention to the perennial question of changes to the delivery of hospital services in Wales, and raised some key points. It’s a thorny issue, and it’s difficult to get to the right answer.
Politically, any attempt to remove services from local hospitals will be painted as centralisation, and is certain to stir local protests. But, as Matt points out, there are serious concerns that the current situation is actually unsafe in certain respects, and that isn’t really a political issue.
It often looks as though the professionals themselves are split on the issue; whilst some express their fears about centralisation, others equally sincerely express their concerns about patient safety.
As far as I’m aware, no-one is suggesting that all hospitals in Wales should have a team of qualified brain surgeons on hand. The annual number of cases simply does not require that level of provision. Generalising from that, it is clear that there is, therefore, a willingness to accept that certain specialised types of care are best provided in a smaller number of hospitals which have the expertise and the facilities to cope with them.
Again, as far as I’m aware, no one is really suggesting that district hospitals in Wales should cease providing a good level of general surgery and medicine covering most of the illnesses which affect significant numbers of the population.
The problem is in drawing the line between the two. Whilst we all want to be treated as locally as possible, how many of would really prefer to be treated by a team who’d never seen a case like ours, instead of by an experienced team which dealt with a number of cases each year, just in order to be more local? Give me the expertise any day. And that question is what should be at the root of the government’s case for change.
To read some of what the professionals and politicians are saying, the failure of the government to convince us that they’re drawing the line in the right place is a ‘presentational’ problem; all they need to do is find a better way to put their case and we’ll all be convinced. (Or even, as the WM article suggested, simply find the right time between elections where they won’t suffer too much political grief as a result.). I think they’re deluding themselves.
Against a background of previous attempts to centralise services, in what generally looked as proposals more motivated by financial considerations than by health care considerations, it should be no surprise to anyone that there is a good deal of suspicion about any proposals emanating from the government. There have been previous proposals which were about centralising whole services rather than just the most complicated and unusual of cases, and it often appears as though those proposals are simply being recycled under a different banner. They’ll need more than good PR to shift that perception.