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Central Consultants and Specialists Committee

15 December 2006

Dear Colleagues

The Central Consultants and Specialists Committee met on Thursday 14 December and tackled a wide range of issues that will be covered in a circular next week. The meeting focussed on various key parts of the NHS reform programme, such as referral management, payment by results and hospital reconfiguration. Members of the committee were able to question a top Department of Health official working on Payment by Results and to put forward the profession's many valid concerns about PbR.

The committee also dealt with Modernising Medical Careers, the National Programme for IT in the NHS and CCSC evidence to the Doctors and Dentists Review Body. It will be producing further guidance and communications on many of these matters soon.

Hospital reconfiguration is a particularly pressing matter. The following statement on hospital reconfiguration sets out the CCSC's view and it will be issuing more detailed guidance shortly.

Jonathan Fielden
Chairman, CCSC


RECONFIGURATION OF HOSPITALS – STATEMENT FROM THE BMA’S CENTRAL CONSULTANTS AND SPECIALISTS COMMITTEE

Following recent Department of Health announcements about the viability of many District General Hospitals, particularly the statement that as many as 60 may not have a future, the CCSC has listened to concerns being expressed by consultants, and shares many of them.

It is absolutely clear that reconfiguration undertaken purely to save the NHS money is unacceptable. The financial crisis in the NHS cannot be denied and the CCSC understands that this has to be addressed. However, valuable patient services must not be reduced, or their quality suffer, in the process of fixing this problem.

We therefore oppose any local reconfiguration plans that are based purely on financial expediency or that risk patient care in any way. We oppose any policy that earmarks a certain number of DGHs for closure to meet an imposed financial target.

We do recognise however that in many cases the reconfiguration of hospital services can be justified on other grounds. An underutilised A&E centre that is not greatly benefiting its local population, for example, may be drawing resources away from one that desperately needs more capacity. Provided a good patient transport infrastructure is put in place, it may be justifiable to close that unit.

Reconfiguration may therefore be acceptable where it is:

• evidence-based
• clinically-led
• safe
• and maintains or enhances standards of care across a health economy.

All these criteria are essential in securing the support of consultants for reconfiguration plans in their locality. It is essential that clinicians are involved from the outset in building the evidence and engaging with the public over the reasons for the changes proposed.

The CCSC will shortly be producing a general good-practice guide to help consultants in their involvement in any such plans. It is also making regular representations to Ministers encouraging this approach to reconfiguration, particularly early clinical engagement.