Health Matters | Paul Corrigan's blog

Last Friday a pamphlet with the above title to which I contributed was published by Reform which received some publicity in the papers and on the Today programme.

The rationale for this pamphlet will not surprise blog readers. Over the past couple of weeks I have posted on several occasions with examples of the growing clinical concerns about safety and the current configuration of hospitals. The evidence is there that the variations of outcomes that exist between hospitals are in part caused by this configuration. It will not be long before clinicians refuse to work in unsafe hospital environments.

Of course challenging this hospital configuration is only a part of the story of necessary reform. But it is an important part.

It is no secret that over the next few years the increase in demand for NHS services will not be met by a similar increase in resources. Unless we can significantly increase health care outcomes with the same resource, the NHS will run out of money. This is why we need to improve the value for money provided by our hospitals.

The traditional offer that NHS hospitals have made to the public can no longer be sustained. For over 60 years we have been led to believe that every hospital can provide us with every service all of the time. If this was ever true, improvements in modern medicine have now made that an impossible promise to deliver.

Already financial pressures are making a number of hospitals unsustainable. In June 2012, the Department of Health said that 21 NHS hospitals are “clinically and financially unsustainable” and will need restructuring.

There is now a coalition across much of the medical profession, the leadership of the NHS, and most national patient groups arguing for radical restructuring of hospital services..

There are of course conservatives on both the political right and left who will try and stop this restructuring from taking place but the size of the problem means such complacency cannot solve the problem.

Traditionally the problem has been ducked by merging failing hospitals with each other. Earlier this year a survey of NHS hospitals commissioned by the Health Service Journal found that 75 per cent of them are considering or are actively involved in mergers and acquisitions.

Developing mergers between unsuccessful NHS hospitals because you cannot find anything else to do with them is not going to suddenly make mergers a successful method of improving failing hospitals.  Bringing together one failing hospital with another generally simply creates a larger failing hospital.

As in other services it is possible to develop a better hospital from the core of a failing one, but this can only be achieved by a profound and systemic change to the structure and the services of the hospital.

The surest way of achieving this, is not by a merger of equals, but by the takeover by a very successful hospital of the failing hospital. We know that takeovers only work when the acquiring organisation changes the business model and the working practices of the staff.

There are two sources of expertise that could take over failing hospitals.

First there are some successful NHS Foundation Trust hospitals that have the experience and the capacity to carry out the necessary radical changes.

Second there is a growing expertise in the private sector in turning hospitals around. This year, Circle became the first private company to take over the management of Hinchingbrooke, a failing NHS hospital in Cambridgeshire.

However neither of these groups of institutions is compelled to take over failure. They will only do so if there are the correct incentives. At the moment the Government is financially subsidising failing institutions. Some of this resource could be spent on assisting successful takeovers.

We may end up with chains of hospitals run by the best NHS Foundation Trusts and private companies who could develop centres of clinical excellence with strong brands. They would cut costs and improve the quality of the care delivered to patients, spreading best practice and achieving economies of scale.

Sooner or later, the Government will have to acknowledge both the clinical and economic case for radical change amongst NHS hospitals. The sooner it does so, the easier it will be for local change to be pursued with a prospect of success.