"We will stop the forced closure of A&E and maternity wards, so that people have better access to local services, and give mothers a real choice over where to have their baby, with NHS funding following their decisions." (Conservative Manifesto 2010, p47)These are very clear: the closure of a local service will only happen if there is local support for the decision. This is a controversial approach because on the one hand local people will never agree to the closure of a local NHS service, but on the other hand smaller units cannot support the expertise that is needed and this can put patients at risk (for example The Oxford Cardiac Centre at the John Radcliffe Hospital). Like it or not, there must be some central control based on expert opinion, but the local population must be informed about the reasons.
"We will stop the centrally dictated closure of A&E and maternity wards, so that people have better access to local services." ("The Coalition: our programme for government", 2010)
At the election Andrew Lansley was clear about this, for example, at a protest at Solihull in May about the planned closure of a maternity unit:
Mr Lansley told The Observer [that] a Tory government would stop the closure of maternity and A&E units if elected, and said hospitals were now "overridden with bureaucracy." "These decisions must be brought back to a local scale," Mr Lansley added. "We must consult openly with GPs and then the public."You cannot mis-interpret this statement; Lansley says that GPs will be consulted and then the public, and closure will happen only if they agree with the plans. This is a very popular message and is the sort of thing that politicians say to get elected. But then when they are in charge of the service they have a re-think. Now Lansley is responsible for the NHS he is reneging on his manifesto pledges:
"Maidstone and Tunbridge Wells NHS Trust plans to move maternity services away from its local district general hospital to the PFI-built Pembury hospital. But a survey of 127 local GPs found that 91% opposed the plans, believing both hospitals should provide consultant-led maternity services."This is quite clear: the local GPs want the unit to remain open. So what is Lansley's response?
"Health secretary Andrew Lansley has said plans to close a maternity unit in Kent will go ahead despite opposition from local GPs."New politics? No, just the old politics of promising one thing to get elected and then doing something else when you are in office.
Pulse report that
"The BMA, the NAPC and the Family Doctor Association have all told Pulse that trusts in different parts of England have been forging ahead with proposals, including the closure of hospital A&E departments, maternity units and children’s services, against the wishes of the local GPs. "In addition they say that "in the capital a string of trusts in northeast London are pushing ahead" with closures. However, there are worrying signs of infighting between GPs and the very managers who they will depend upon to do commissioning when (if) GP commissioning goes ahead. Pulse quotes Dr Peter Swinyard, chair of the Family Doctor Association as saying:
‘When the night of the long knives comes and PCTs are abolished, the good PCT managers will find themselves a home in GP consortiums. Those who have behaved irresponsibly and ignored the wishes of GPs will find themselves down at the dole queue with no future ahead of them.’This is a level of bluster that Commissar Lansley likes. The fact is, most GPs do not know how to do commissioning and do not want to do it, come the "night of the long knives" it may well be the case of GPs having to beg the PCT commissioners to come and work for them.
What is clear is that the empire building is clearly started and some GPs are very keen to become fully fledged captains of business rather than what the public really want from them, which is to be doctors.