The Times printed a piece by Kat Lay which will stir the embers of injustice in the Welsh Valleys. On 5th Feb she writes: Patients “hurt by hospitals that merge”, but the article is not “on line”. Choice has been limited within Wales for a few years now, and different CCGs in England take differing approaches. A second opinion in Wales can be sought easily if its within ones own trust (where all specialists in a department meet regularly and think the same) but to get a genuine second opinion is not possible without private means.
Merging hospitals will improve standards, but it should not exclude choice and second opinions in a liberal society. You might argue that our 4 Health Services are in such a parlous state that the restriction to individual liberty is justified by the gain to the population as a whole. John Stuart Mill argues that this is the only justification for such restriction of liberty. Hence taxation is justified, health and education are mutualised, and social safety net has moved on from the poor house or the workhouse.
In areas where travelling time is significant, transport systems are relevant to quality of care. There is a big difference between A&E attendance (speed, access) and cold referrals (quality, choice). A government that put its money into prevention should then focus more on cold referrals if you are unlucky enough to get a “black swan” condition, or need A&E.
I happen to live in a rural area, with a soon to be closed teaching hospital. I live in an area with poor and slow transport. The road east can be blocked by dozens of agricultural or industrial HGVs. My chances of a stent to save my heart attack, or clot busting treatment for a stroke, of killing me, will be much greater that those who live within 20 minutes of a merged facility…. depending on where it is located. Air ambulance is a charity, and we cannot depend on helicopters as the numbers are too large.
Hospital managers harm patients because they reduce competition, according to a watchdog report.
A typical merger plan costs the NHS more than £2.5m a year as a result, the Competition and Markets Authority found.
The report said that falls, pressure ulcers, blood clots and Urinary Tract Infections could almost treble if a merger created a local monopoly. It also estimated that deaths could increase by almost 500%.
Health policy experts said that the findings were interesting but questioned the watchdog’s conclusions. Nigel Edwards (Formerly policy director of the NHS England), chief executive of the Nuffield Trust, told the Health Service Journal: “The conclusion that a merger will increase death rates is completely illegitimate and an over-extension of the analysis because there are other factors driving this”. They included whether a hospital was in a rural area or used for teaching, he said.
The study used NHS statistics from 2013-15 across eight hospital specialities that covered about two thirds of admissions. Since 2006 patients ( In NHS England, not Wales or Scotland) have had the right to choose the hospital where they receive treatment.