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25th February 2016

Balancing central and local services

Mr. Robertson, a recently retired NHS Chairperson for Greater Glasgow and Clyde has thrown a new perspective on how to balance increasing demand on health services with the need to maintain standards in times of restricted funding.

In public interviews he pointed to the recent moves in Greater Glasgow NHS to centralise A&E services in one new 'Super hospital', reducing the departments from being based across the city in five separate hospitals. The restructuring was agreed in 2002, and has only last year come to fruition with the opening of the Queen Elizabeth University Hospital. This absorbed the previous A&E departments and other specialist services from various city hospitals.

Other health experts agree with his view: reducing the number of locations for A&E services has several advantages. It allows for a concentration of expertise and developing best practice, where professionals are concentrated in nearby teams with easy access to expert consultants. Further, since the team will be exposed to dealing with special medical problems more often, they will be able therefore to more quickly develop best practice through experience.

Most importantly perhaps, the centralisation of public access to A&E should allow funding to be diverted from the closed A&E departments to improve more local, generalist and preventive support services. These would include more home care, housing support and community medical services such as community nursing and increased GP services. So the promise is that hospitals with A&E can gradually increase their throughput and expertise, assisted by better community services gradually reducing the demands on these hospitals.

It seems like a logical and inspired solution to the perennial demand/funding crisis in many hospitals: better community care, higher levels of expertise in hospitals and better outcomes for patients.

But there are conditions and obstacles. Mr. Robertson was very admiring of previous Health secretaries who supported the restructuring plans, in the face of often outspoken criticism and opposition. Closing hospitals or their departments has never been politically easy. It requires Government will and public support to continue to divert resources form these previous distributed specialist services, to provide more preventive community support. Increased investment in community resources may require further decisions on rationalisation and centralisation of expertise.

The Government is noticing an improvement in waiting times already, although in some areas not all waiting time targets are being met. There are changes in funding for local services coming about through changes in Scotland's fiscal framework. More of locally raised income tax will in future be directed to services in the areas where the taxes are raised. We hope that this will help to rectify the imbalance, improving local an d preventive services while allowing hospital resources to be concentrated on what they do best, providing expert medical support in specialist areas.

*All information is correct at the time of publishing

Tony Clarke

Scottish Care Inspectorate Specialist

Tony began care work as a care assistant in care of the elderly here in Scotland in the 1970s. He very much enjoyed promoting activities, interests and good basic care.After a gap to gain a social work qualification, he worked in management of care services, latterly as a peripatetic manager which gave him experience of a wide range of services. Read more

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