Heat not light

Tweet This week has seen the publication of proposals by two of Wales' health boards for changes to the way some services are delivered.  Political reactions have, more or less, been entirely predictable, and based more on political considerations than on any relating to health.  It’s one of those situations where all of the politicians in all of the parties know that there have to be some changes whilst politically they all want to appeal to the sensitivities and sentiment of electors across Wales rather than risk losing votes by saying why they support some change.

That is not to say that the health boards necessarily get everything right, and that there is no scope for debate about some of the detail.  And the lack of trust which has grown as a result of previous attempts to rationalise services – sometimes for financial rather than health reasons – has left a legacy of suspicion about motives and rationales which leave a strong motivation for those opposed to any change.

Having sat through a number of meetings where some of these issues have been discussed, three things in particular have become clear to me.

1. There are people who are inpatients in our hospitals who need not be.  With proper organisation and by putting the funding in the right place, their care could be delivered in the community – usually in their homes – with sometimes better outcomes; almost invariably with more dignity and independence for the patients; and often at lower cost.
2. There are a number of complex cases and specialities, sometimes involving expensive equipment and needing particular expertise, which can be delivered more safely and with better outcomes from a small number of centres than by attempting to replicate services in every hospital in Wales.
3. Medicine is becoming increasingly specialised; specialist skills need to be maintained and developed by handling a sufficient number of cases, and doctors in some specialities are in short supply.

Those three points seem to me to be unarguable; the question is about which changes need to be made to respond to those factors, and whether – as a suspicious public fears – the changes being proposed go further than is necessary simply to respond to those three factors.  That question needs more attention and debate than it is getting from knee-jerk political reactions phrased in emotional terms about ‘saving our services’.

Those proposing the changes are not infallible; and I’m not assuming for one moment that they have got it all right.  But simplistic opposition to any and every proposal is not the best way to get the health service we need and deserve.