The NHS needs to be honest about the case for service changes

The debate about service change in the NHS is in danger of being sidetracked.

While public concerns about local service change programmes understandably focus on what people see as the risks, the NHS needs to get much better at explaining both the need for change and the benefits.

We have recently worked with a number of fellow NHS communicators to develop best practice principles for communicating NHS service change.

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We need debate

In talking to those involved in different programmes, what was striking was the similarity between the arguments and materials used both for and against change across the country.

‘The similarity between the arguments used both for and against is striking’

What was perhaps more surprising was, given this, how little networking and sharing of information had taken place between such programmes.

This underlines not only the need for the national best practice approach we are proposing, but also for a national debate about how the NHS can best serve and engage with patients in future.

When reconfiguration programmes propose changes to services at local hospitals, some degree of opposition is always likely to be inevitable.

Whatever the merits of the case for change, politicians fear that being seen to support any “downgrade” at their nearest hospital will cost them votes, while fears about travel times to hospital, “privatisation” of services, or proposals being financially rather than clinically motivated can dominate the public discourse.

It is these largely unfounded fears that the NHS needs to tackle head on.

Tackling the clinical and financial issues

On travel times, there can be a trade-off between quality of care and distance of travel, but it is now widely accepted that in terms of saving lives, getting to the right clinical team is usually more important than how far you have to travel.

‘Service change programmes have been wrongly conflated with the Health and Social Care Act’

Changes to stroke, major trauma and heart attack services in London led to more people travelling longer distances, but the quality of care in specialist centres has transformed outcomes for the better.

The key on travel times is that clinicians advising the programme must be content with any expected increase and that programmes are advised by experts and follow best practice in estimating journey times.

The NHS also needs to address the fact that service change programmes have been wrongly conflated with elements of the Health and Social Care Act, leading to them being seen as some kind of move towards privatising services.

The simple fact is that moves to change the way NHS services are delivered, with more focus on services outside hospital, predated both the Health and Social Care Act and the current government by some margin.

There is consensus that more care needs to be delivered in community based settings such as GP surgeries and community hospitals rather than in hi-tech, specialised hospitals, which should be larger, more centralised sites.

While reconfiguration is not a panacea, it is attractive to clinicians and managers because it can address both the clinical and financial challenges faced by the NHS – genuinely providing more for less, as in the case of the changes to stroke, major trauma and cardiac care in London.

Such changes would seem likely to make the current system work better, undermining the arguments of those who would like to see the NHS model of provision changed.

The NHS must be honest

Finally, the argument that proposed changes to the NHS are “all about saving money” needs a head on, honest response.

If service change proposals have a financial element, or even if the case for change is primarily financial, those leading the change should say so.

Services that are not financially sustainable will soon become clinically unsafe - there is not a zero sum game between clinically and financially motivated changes.

Substantial increases in NHS funding for the national body in the years immediately ahead are highly unlikely and the pressure on public finances is widely understood.

‘Addressing the issues requires leadership and widespread public engagement and discussion’

The NHS should be honest about both the financial and clinical case for change, as most reconfigurations include both elements.

Addressing all these issues requires robust clinical and managerial leadership and widespread public engagement and discussion.

Service change programmes need to follow best practice at all levels, to ensure their processes are sound and fair and that they listen and respond to everyone, not just those who shout loudest. 

The NHS does not need to rely on “spin”. It just needs to be honest with people about the scale of the clinical and financial challenges it is facing and why it proposes reconfiguring services in some areas as a solution.

Importantly, service change programmes everywhere should follow similar best practice principles and efforts must be made to move the debate at national level beyond shibboleths about privatisation and cuts.  

Rory Hegarty is communications and engagement director of the South East London NHS Commissioning Strategy and Luke Blair is equity partner and board director of the London Communications Agency