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Specialist stroke centres and GPs' supersurgeries won't mean hospital closures in London, the health secretary, Alan Johnson, has told MPs.
At this first opportunity to be grilled by his peers since taking up the post a month ago, Mr Johnson reassured the health select committee that the proposed reforms do not carry a hidden agenda for more cuts (BMJ 2007;335:61, 14 Jul doi: 10.1136/bmj.39273.467697.DB).
Doug Naysmith, MP for Bristol North West, was one of the many committee members who feared that they might. Stroke centres would offer scans in three hours, he said. “That must reflect on the future of large hospitals because we can't have 10 or 12 of those in London because we just don't have the facilities, and that means concentrating down.”
“That is true, but it does not mean other hospitals closing down,” replied Mr Johnson. “For example King's [College Hospital] has a very good stroke centre but that has not led to the closure of other hospitals in south London.”
Mr Johnson admitted that despite huge investment in the NHS, “We have got a negative perception among the public and a feeling by the staff that the changes that have taken place that have led to better outcomes have been done to them rather than for them.”
The idea of GP led polyclinics seemed to be another change for change's sake, said Howard Stoate, a GP and MP for Dartford. “What work has been done on them and their impact on cost?” he asked.
Dr Stoate was referred to the junior health minister, Ara Darzi, whose idea it was to introduce them. But the health secretary said that although they might be right for London, they would not necessarily suit other places.
Mr Johnson said that he and Professor Darzi would listen to NHS staff to inform their recently announced NHS review, reiterating his compulsion for “bottom up” decision making several times.
To help with this the number of centrally imposed targets has been cut by two thirds, but there was “no target for reducing targets,” he said.
The prospect of a new NHS constitution, which could follow the review, bothered some committee members.
Mr Johnson said that there was no blueprint for it, and it would be based on what came out of the review.
Richard Taylor, MP for Wyre Forest and a retired consultant, pointed out that the introduction of independent sector treatment centres had been carried out without properly integrating them with local facilities. This had lead to problems between NHS services and private providers in the areas where the centres operated, notably among orthopaedic surgeons and general surgeons, he said.
Mr Johnson conceded that the government had “not got integration . . . at the right level yet.”
A report last week from the Healthcare Commission criticised the centres for not providing adequate data about their performance for them to be properly compared with NHS services (BMJ 2007;335:173, 28 Jul doi: 10.1136/bmj.39283.486551.DB).
Mr Johnson defended the centres, saying that they had made an important contribution to reducing waiting lists. He took the opportunity to announce government approval of another one—for Cumbria and Lancashire—which would carry out 11000 procedures a year.
“I expect to approve more schemes in the coming months,” he said, adding that this was only as long as they met local need and offered value for money.
But he said that such decisions would be informed by local wants and needs and that there would be no third phase of government procurement of independent centres.
He was, he told MPs, ending the contract with the diagnostics provider, Atos Healthcare, for the north west and south west, for example, because it couldn't deliver services to deadline.
When questioned about the problems surrounding Modernising Medical Careers and its online recruitment process, the medical training application service (MTAS), Mr Johnson admitted that “lots” of doctors could be unemployed in October.
He said, “Everybody was right about changing the process, and everybody was behind it. It went wrong somewhere between good idea and application, which needed more attention.”
But he said that he did not anticipate an “enormous problem” on 1 August, when junior doctors should take up their new posts, but he was concerned about junior doctors who were not in the first phase.
Sandra Gidley, MP for Romsey, asked, “So at the end of the second phase [in October] potentially there could be a lot of doctors unemployed?”
“Potentially, yes. That is what we are working on now,” replied Mr Johnson.