An actual threat to the future of hospitals

Date published: 11 September 2023

Concluding our series of blogs to mark the 75th birthday of the NHS, DoH Director of Communications David Gordon warns against ‘self-fulfilling conspiracy theories’.

NHS 75 blog - Director of Communications David Gordon

There is a threat to the future of some of our hospitals, but it’s not what you might think.

It involves what might be called self-fulfilling prophecies of doom.

These can stem from the best of intentions, but that doesn’t make them any less destructive.

Here’s how it works.

A change to services at a hospital is announced.

This is followed by high profile claims that the change is part of a secret long-term plot to downgrade or even close the entire hospital.

Allegations like this immediately grab headlines.

And the conspiracy claims can be impossible to kill off – no matter how many official denials are issued.

They can often become the central point of ongoing media coverage and public debate about the hospital.

And the risks grow. The key to delivery of high-quality services is the right number and quality of clinical personnel.  The rumours mean retaining clinical staff becomes harder.

With employment opportunities available in other parts of the health service, some existing staff might be tempted to move to another hospital that does not have constant speculation over its entire future.

Likewise for recruiting staff. A doctor or a nurse thinking of applying for a job might well Google the hospital to learn a bit more about it. And what do they find? A string of headlines about threats, closures and secret agendas to run it down. It’s an obvious deterrent, especially when there are alternative posts available elsewhere.

The self-fulfilling conspiracy theory is in play – an exercise in slow corrosive destabilisation created by the people most anxious to avoid this outcome.

Imagine, however, if that doctor or nurse’s Google search found that this local hospital provides a suite of defined key services for its community and is also a critical part of a wider network. Might that not be a better prophecy to fulfil?

As was said by senior political leaders at the time of the Bengoa Report publication, our choice is between planned change in our health service or letting change unfold in a random, haphazard fashion.

It is, of course, the case that changes to health services often cause concern in local communities.

But simply opposing change won’t stop it happening. And lambasting any reorganisation of services whatever the circumstances or evidence is counter productive.

It’s entirely right and proper to speak up for hospitals, to value the work they do and emphasise the importance of accessibility to services. And also to hold to account those who propose changes.

However, it’s an indisputable fact that modern medicine requires increased levels of specialisation by clinicians. And that means some hospital services need to be concentrated in specialised hubs. The days of every hospital providing every service are gone and won’t be coming back.

All health services face hugely difficult challenges in balancing the accessibility of services on the one hand and ensuring their sustainability and quality on the other.

To take one extreme option, imagine just one big regional hospital serving the whole of NI, providing the full range of services to the entire population. It would have its advantages in clinical planning terms – large resilient staff teams with ample opportunities for specialisation and sub specialisation in their chosen fields; large patient numbers to provide a highly varied case mix and ensure skill sets are constantly honed and developed.

Of course, this hypothetical single hospital would in reality be totally unfeasible. It would bring huge accessibility issues for patients.

The polar opposite approach would be to try to run acute hospitals in every one of our towns.

That would resolve accessibility questions.

But it wouldn’t work either. You wouldn’t be able to staff that many hospitals with the required number of doctors, nurses etc.

This would be the case even with unlimited funding to train staff and unlimited numbers of people able and willing to do these jobs.

It’s down to patient numbers – clinicians need patient throughput to be at a sufficient level to maintain and develop skills and experience.

Having a hospital in every town clearly can’t and won’t happen. Just like the idea of one big hospital for all of Northern Ireland.

So we have to find the most appropriate point somewhere between those two extremes.

Local hospitals are part of the solution – delivering services locally but also playing a role in a network of centres of excellence, delivering for all of Northern Ireland.

It would be wrong to pretend any of these decisions are easy.

However, opposing change of any kind is not in the best interests of patients – or indeed hospitals.

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