A tale of two countries.

Now everyone wants to shut down our hospitals – NHS managers meeting at their conference, the Royal College of G.P’s, M.P’s. Everyone except me.

Has no one learnt from the last time? It didn’t work then; have a look at ‘Merger Mania’, my series of articles based on an academic study into the wholesale closure of hospitals in the early years of the Blair government and the similar process in America in the Reagan era. This study showed that the closures did the opposite of what was really intended; standards fell, outcomes worsened, management costs increased.

Specialisation is sometimes a good idea – for planned operations and for treating strokes. As we learn more, we will probably realise that there are other specialisms that should be dealt with on a more centralised, specialised basis. There are many other procedures that are better done locally.

None of us would have chosen the system we have – If I had the choice I would go for a system of local ‘Polyclinics’, state run centres dealing with all first aid, minor operations, GP services, dentistry, pain relief, ante/post natal, community mental health, chiropody, pharmacy, hearing aids, opticians, you name it. A one-stop health shop.  Something much more than a General Practitioners but less than a hospital. Open till late, it would deal with all the walking wounded.

Hospitals would be centred around ambulance/paramedic initiated Accident and Emergency and complex elective surgery. Surgery would be more advanced, specialised and centralised to benefit from the concentration of skills.

As it is, we are going to end up with giant, distant, remote hospitals as well as no local services. The worst of all worlds.

Of course, once we had a system of local cottage hospitals but they were all shut down against our protests, to be replaced with the big general hospitals they now want to shut down.

OK, here’s a tale of two countries –both very similar in outlook, population and with a shared history; The UK and the Netherlands.

The first table is for the UK and shows how in the Blair era we had a huge decline in the number of large general hospitals as well as an increase in private hospitals registered to do NHS work, stealing public money and jobs out of the system:

Table 2: Hospital Market Structure, England, National Health Service,

1997-2007

 

Year # NHS Hospitalsa #Mergers            Private Hospitalsb

 

1997            227                   26                           

1998            214                   21                           

1999            202                   17                           

2000            193                   23                           

2001            188                   25                           

2002            174                     6                           

2003            171                     0                             

2004            171                     0                            3

2005            171                     3                          21

2006            168                     3                          32

2007            167                     0                    

 

 

 

a Source: U.K. Department of Health. Hospitals with fewer than 5,000

consultant episodes per year are excluded.

b Independent Sector Treatment Centres. These are private hospitals

with contracts with the NHS.

 

You can see the decline in the number of general hospitals in the first column, the spate of mergers 1997 to 2001 and then in the fourth column the increase in the number of private hospitals from 2004 on.

The process has continued and is now going to increase as Trust mergers will be looking to make hospitals ‘pay’ while everyone wants to do private work.

This second table is for the Netherlands – you can see a similar process of big general hospitals closing and merging, but at the same time a big increase in the number of local clinics dealing with outpatient operations:

Table 3: Hospital Market Structure, The Netherlands,

1997-2010a

 

Year # Hospitalsb               Outpatient Treatment Centersc

1997          117                                |

1998          117                                |

1999          115                                |

2000          111                                |

2001          104                                |

2002          102                                |

2003          102                                |

2004          101                                |

2005            99                              37

2006            98                              57

2007            97                              68

2008            97                              89

2009            95                            129

2010            94                            184

 

 

 

a Source: Netherlands Healthcare Authority.

b Total # of hospitals, including general hospitals, spe-

cialty hospitals, and university medical centers. The

vast majority are general hospitals.

c Independent Treatment Centers (ZBCs). These are

freestanding outpatient treatment centers, not part of

hospitals.

127

Now doesn’t that make a lot more sense? Which country has the queues at Accident and Emergency, I wonder?

Alright, I’m biased but this process in Holland ollandHollandhas been planned for patients to get the best outcomes, rather than change by accident which is the way we have been developing our NHS in the UK.

Neil Harris

(a don’t stop till you drop production)

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