A lot more NHS cash – yes, but no restructuring | @guardianletters

The government need to listen to David Nicholson’s stark warnings that the NHS are not able to survive if it is denied “extra money”, but one more best-down reorganisation is not the answer (NHS informed to commit billions on reform or face oblivion, 13 March). It are not able to sustain services offered the combined pressure of increasing patient demand and falling assets. Modify that puts medical professionals and sufferers at the heart of decision generating is required, but centralising hospital services would be an needless restructure that would harm the versatility to react to the wants of local communities.

The government need to guarantee that clinical needs come initial, NHS providers reflect the neighborhood needs of sufferers and, as Nicholson says, our health service have to have the sources to deliver these solutions. Patients have to get the greatest achievable care – which centralisation and budget cuts will not offer.
Dr Mark Porter
Chair, British Health-related Association

• David Nicholson and others who keep banging the drum for a substantial reduction in the quantity of hospitals to offer money for care closer to patients’ properties are currently being disingenuous. It really is not just a question of bricks and mortar, as Nicholson asserts hospital closures usually indicate enormous bed reductions, yet even now we have far fewer hospital beds in proportion to population than the OECD average – half as many as France, for example. How can cutting them more be a secure and sustainable approach with a expanding and ageing population?

It can not be a query of 1 or the other. As Dr Saleyha Ahsan mentioned in her riveting piece primarily based on direct encounter (On the NHS front line there is no swift cure for the crisis, five March), enhanced care in the community is crucial “but if a lot more acute beds shut, the A&ampE waits will get longer for sick individuals requiring admission”.
Professor Ron Glatter
Hemel Hempstead, Hertfordshire

• It really is a small late for the outgoing chief executive to say the NHS demands a multi-billion pound change fund to rationalise hospital solutions. But his fundamental stage, that we need to invest in local community companies and assets prior to dismantling hospitals, is sound. Otherwise the public will never ever feel it is something other than expense cutting. And it is why there isn’t much to demonstrate yet for shifting care out of hospitals it just is not achievable to close providers at the same time as opening new ones.

It is interesting that he is utilizing the identical language of the mental hospital closures 30 many years ago. Thirty many years on we will be hunting back in astonishment at the way we employed to care for the frail and elderly in the final months of their lives, in institutions that are created for healthcare therapy rather than the care and compassion we largely require. This is essential. We have completed it prior to in even less promising situations – with the added stigma of psychological sickness – by creating a huge programme of alter and institutional closures. Nicholson’s message aligns fully with our manifesto for primary care, which launched exactly a single yr in the past. Our message to the incoming NHS chief executive is easy. Please just do it: launch the adjust fund.
Rick Stern
Chief executive, NHS Alliance

• The interview illustrates Nicholson’s isolation from actuality. To instance the provision of care in the neighborhood following the closure of extended remain psychiatric hospitals in the 1980s as a accomplishment is exceptional. He should read Care in the Community Myth or Actuality, a review that paperwork the experiences of 750 former sufferers of Friern Barnet hospital. Briefly, many showed some progress in their initial year, followed by a continuing decline in subsequent many years, since of the lack of proper investment in local community mental health services. This predicament continues and accelerates right now, with the closure of psychiatric beds, closure of rehabilitation solutions and below-provision of appropriate supported housing. Support is often presented by low-paid, unqualified employees.

The puzzling announcements by government of equality of provision for mental wellness with physical well being at the very same time as announcing cuts to an currently inadequate mental health budget is deeply troubling. We require to be profoundly concerned.
John Holmes
London

• The Nationwide Overall health Action Party has place forward plans to increase value for cash in the NHS based mostly on disregarded operate completed in the course of the final parliament:

Guarantee that all remedy is based on proof of effectiveness and ideal worth. Abolish the pricey industry in healthcare and the purchaser/supplier split. GPs and hospitals could then operate closely with each other to make certain that only people who are not able to be cared for by enhanced local community providers want admission to hospital. Patients with minor and lengthy-phrase illnesses need to be taught to care for themselves much more independently. Tackle weight problems, smoking and extreme alcohol intake far more efficiently.

Of course Sir David Nicholson is appropriate: money would have to be invested on strengthening local community care prior to these cost savings could be made. The outcome could conserve the NHS as a publicly provided and funded services for future generations.
Richard Taylor
Co-leader, Nationwide Health Action Celebration

• Yes, we want to be confident that acute companies are obtainable in sensible locations. Even so, the sole criterion need to not be based purely on population. It is also simple for a Londoncentric NHS to style companies this way utilizing minimum population as 1 of the major criteria is taking a sledge hammer to crack a nut. Get vascular surgical treatment. Rurality, transport and street entry, age demographics and deprivation must all be calculated when we determine where we supply our acute centres. With out this we will merely be condemning these who are elderly and residing in rural areas to a even more dimunution of services.
Rik Evans
Truro, Cornwall

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