NHS service closures – does temporary means temporary?

There isn’t much that fires a local debate on health services than a service provider using emergency measures to withdraw a service. Debate is rarely more heated when the closure affects cherished services like A&E or wards at local community hospitals.

Chatter around hospital trusts using these powers has been mounting among campaign groups for some time. And now it’s reached the Prime Minister’s very public inbox during her weekly set-piece interrogation in the House of Commons.

In among questions on housing and homelessness from Jeremy Corbyn and arguments about Brexit with MPs from her own party, Tory Member of Parliament for Grantham, Nick Boles, asked when it comes to the closure of Grantham A&E does temporary mean temporary?

The Prime Minister noted in her answer that safety of patients is indeed the first and most important consideration for our hospitals. Who would disagree?  Setting care quality standards is a complex issue and the minds that have considered and created the published requirements have done so reasonably and appropriately.

So if we all agree that the safety of patients comes first, why isn’t everyone reassured when hospital trusts use these temporary measures to deal with unforeseen or emergency events?

The reality is that largely we are.

When a ward is closed because staff or patients are affected by a vomiting bug, or some other infection. Or when utilities failure means the service can’t operate safely. When a particular issue is genuinely unforeseen, the public is likely to accept the closure as necessary.

It’s when temporary change powers are used to address predictable situations that sceptics could (and often do) suggest the trust in question has used them to cynically circumvent its duty to consult local politicians or involve patients and the public in service change decisions. And while NHS commissioners mostly back these decisions in public, in private they are often as annoyed as any local campaign group would be.

Don’t get me wrong. The trusts are in an often impossible position: Critical services; strict quality standards to be maintained; the consequences of failing a patient acceptable to no one; severe shortages of qualified staff; and a track record of poor transparency on those matters with their local publics.

The ability to close a service on a temporary basis is an important function of running health services safely and the trend seems to be towards more cases where predictable recruitment challenges lead to staffing shortages that are cited as reasons for temporary closures. Independent reviews of these cases have pointed out that these circumstances do not arise overnight; that it’s not surprising there is scepticism about the extent of efforts to attract the skilled and experienced staff required; and that temporary doesn’t last long before it becomes in effect permanent. The powers are definitely not, as one NHS hospital trust communications lead described them to me, a ‘get out of consultation free card’.

There are high levels of mistrust in situations where these powers are used and the NHS has a near impossible task to to convince local people that it isn’t using these powers to force through unpopular decisions. Especially where temporary service changes foreshadow permanent closures that are feared or expected.

We’re already seeing these decisions more regularly challenged formally by local councillors and it’s likely that before long campaigners will try bringing a legal challenge, not with the unlikely objective of reversing a temporary service change decision made on safety grounds, but aimed at curtailing the use of the powers for anything but an immediate, unforeseen circumstance in future.

So, does temporary mean temporary? Unfortunately we’re none the wiser. The Prime Minister referred that discussion to the Secretary of State for Health, and for now, temporary closures of service will continue to be a highly contentious and highly visible.