Plans to replace London’s District General Hospitals with new local hospitals providing fewer services carry clinical risks and need more thought, says the British Medical Association (BMA).
Under proposals from Healthcare for London, more patients would bypass their nearest hospital to attend new centralised specialist centres. While expressing support for the aspiration to improve healthcare in London, and welcoming many of the plans, the BMA’s response to the proposals raises concerns about local hospitals being downgraded.
It warns that “although it may be beneficial for some patient conditions for a small number of patients to bypass local hospitals to specialist centres, this is not true for the majority of patients attending A&E”. The downgrading of hospitals, coupled with a lack of nocturnal surgical cover for some services, would mean more critically ill patients being transferred at night, with implications for their safety, the response says.
The BMA document argues that there needs to be more evidence, as well as detailed costings, before changes to London’s healthcare go ahead. It raises concerns that the needs of children who require surgery are not addressed adequately, that the proposals could financially destabilise existing hospitals, reducing their income as services are transferred to other clinical settings, that it is unclear whether the new model is financially viable and that the impact of the proposals on the education and training of doctors and other staff has not been assessed.
Dr Kevin O’Kane, chair of the BMA’s London Regional Council, said: “London doctors share the aspiration to improve health services, but we have significant concerns about these proposals. They’re not supported by enough evidence, they carry clinical risks, and they would leave the average London hospital with a very limited range of services.”
Dr Jonathan Fielden, chairman of the BMA’s Consultants Committee, said: “We welcome plans to reform and update local services when they are in patients’ best interests, based on solid evidence, and clinically led. In the current economic climate, we need to ensure that these plans both deliver high-quality care and represent value for money. Change is needed, but the public needs to understand the profound implications of these plans for London.”