Save the Heart Unit, Save Our Hospital, Save Our NHS!
Save Our Library, Save Our Fire Engine, Save Our School!

Notice, its rarely save (invisible and therefore vulnerable) community services, (unregarded) social care, or (unglamorous) planning officers.

But change in services has to happen, right, so this is just Nimbyism or narrow minded protection of the status quo (implicitly by people who just couldn’t get ‘it’)?

Chris Ham’s recent article in The Observer makes the point that there are up to 20 of our main hospitals which could reasonably be regarded as vulnerable to ‘reconfiguration’ - closure or merger by any other name.  That’s circa 10% of the total, a very significant proportion, especially as the issue here is often not finances so much as the ability to provide either a ‘safe’ service (whatever that means) or a service which meets professional standards (for example about the number of consultant staff in key units, such as A&E or Intensive Care).

A crucial difficulty of course is in part that these are judgements made on the basis of professional recommendations, but they are only that, not more.  They retain crucial value judgements which are subjective, unspoken or unspoken in public.  Professional judgement is a fine thing - I want the doctor treating me or my family to exercise it.  What I don’t want is not to know what is judgement and what is fact, or for it to be assumed that I wont understand if those judgements and distinctions are explained properly to me.

Chris Ham repeats the view that one of the Government’s aims in developing the Health and Social Care Bill was to de-politicise it, and he suggests a way in which, by a small tweek in procedure, that could be done with decisions about hospital and service reconfigurations. (Its about distancing the ‘Independent Review Panel’ from the Secretary of State’s powers and responsibility.)  Which sounds straightforward, except he then goes on to make an apparently simple statement about needing a more honest dialogue with people about such decisions, in a single almost throw-away line.

This is at the nub of why this is such difficult territory.  It is our contention too that such dialogue is needed.  We are dealing here with perceived threat, not just to some remote, unimagined and rarely used service, but to something held dear if poorly understood.   Something which touches virtually everybody at some time.  Something which routinely figures in tv dramas and daily papers, local and national, which inspire intense and witnesses intense emotions.  This is the very stuff of real politics.  The NHS as a ‘state-controlled’ system is a political football, and the Government’s pause reflects just that, and singularly failed to change it, whatever they or Professor Ham (or we) would want.

More recently still, the NHS Chief Executive, David Nicholson has entered the nascent debate to ‘re-assure’ a largely uninterested public that ‘no hospitals will close’ or words to that effect, thereby leaving those who are paying attention wondering just what will close, or put another way just what the parameters are for decisions that trade off ‘public safety’ with ‘local and known’ with financial savings/prudence.  Nicholson’s was as much a message to the NHS as it was to the public.  And of course that too demonstrates the intensely political nature of such decisions. 

There is another phenomenon just now.  That there is a sudden outbreak of ‘hotspots’, where services or local people’s interests are perceived to be under threat, in health take Children’s surgery centres and outer London, take the High Speed Rail line ‘consultation‘, take X or Y items from ‘Cuts watch‘.  And this too demonstrates one of the dilemmas and flaws of our current approach: there is only a very short period in our political cycle when our politicians can countenance ‘threats‘ to local services and interests.  Never mind that Nicholson’s ‘need’ to save £20bn is about re-investment, not actual ‘cuts’, this stuff always gets caught up in a vicious and self-defeating argument about what the real reasons for a given change are. 

We believe there is a different approach - one which works with the political nature of such decisions, one which moves people on from narrow concerns, which brings a reconciliation of professional expert and local and personal perspectives, which neutralises the key question of timing.

It’s the way which embraces relationships and emotion as key context for decisions, which values expert and local knowledge, which seeks collaboration and real ‘added value’.  It engages local people and those affected in the design of new alternatives, in generative approaches and solutions which are only possible because there is a shared commitment to understanding the problems and creating the solutions.  This approach  involves people in the decision-making itself.

To those who still see the world as a linear place, or as a world in which experts are right and resistance to change is wrong, this is a more than a little scary.  It needs careful management of process and an eye for the benefit of emergent approaches.

It is the way described in the Fontis Declaration.  It is the work of Fontis.