Cancer czar: shut down hospitals to fund care

FAILING hospitals should be closed and the money spent on American-style rapid outpatient care, Scotland’s cancer czar said last night.

Dr Anna Gregor accused politicians, medics and patients of being obsessed with saving "old, little hospitals" into which the sick are "emptied".

The government-appointed cancer expert said better results would be achieved by concentrating resources on modern equipment, more specialist clinicians and shorter stays for patients.

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Gregor’s comments go against the conventional wisdom that more beds are needed to speed up the treatment of patients, thousands of whom are facing long waits for operations in Scotland.

The Scottish Executive last night backed Gregor’s remarks, which come just weeks after she and health minister Malcolm Chisholm made a fact-finding visit to the United States.

Gregor told Scotland on Sunday money that could be used to provide more modern centralised services was being wasted on keeping local hospitals open.

She said: "We should adopt a better managed system with fewer beds. We must stop being obsessed that beds are quality.

"We can do with fewer hospitals, absolutely.

"We are obsessed with our old, little hospitals. Every time you try and close one somewhere the politicians march out, local clinical groups march out and patient groups march out.

"We have to persuade patients that their loyalty is not to the old bricks and mortar.

"When we look at the cost comparisons with other health care systems, the biggest difference is our cultivation of beds. We have excess beds in comparison to other systems, in particular the United States."

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The renowned cancer consultant said she had been impressed by the system used by Kaiser Permanente, an American private healthcare provider.

A controversial study published recently in the British Medical Journal showed that the firm, provided better treatment for patients than the NHS for roughly the same amount of money.

Patients face shorter waits and have access to a larger number of specialists and more modern equipment, partly as a result of money being saved by using fewer costly hospital beds and having shorter inpatient stays.

Kaiser Permanente’s use of hospital beds is a third of that of the NHS and Scotland has more beds than the rest of the UK .

Gregor said: "It’s absolutely the way we should go. We need to have a radical rethink, stop emptying people into beds because we have such long waiting times. It clogs up the system and costs money."

Dr Andrew Walker, a leading health economist at Glasgow University, said Gregor was "speaking a lot of sense".

"People assume that more beds are good and less beds are bad," he said. "One night in hospital can cost 300, and that money could be used to provide four or five nurses working in the community instead."

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However, shadow health spokeswoman Nicola Sturgeon condemned the suggestion that the number of hospital beds in Scotland should be cut.

" It’s completely the wrong thing to do," she said. "We have 700 fewer acute beds now than we had in 1999 and it is one of the reasons we have struggled to get waiting lists and waiting times down."

And Jim Devine, the Scottish organiser for Unison, said Kaiser Permanente had faced heavy opposition from health unions in its home state of California.

Devine said: "They launched a campaign under the heading of: ‘Sicker and Quicker’. By making primary care the priority and reducing the number of acute beds Kaiser Permanente patients are being admitted sicker and are being discharged quicker."

Dr Harry Burns, director of public health at Greater Glasgow Health Board, also said he was not convinced by the American model. He warned the study published in the BMJ was "deeply flawed" because it did not take higher social deprivation in Britain fully into account.

"With Kaiser you have your cardiac surgery at Stamford University and then go back to a million-dollar house in Palo Alto," he said.

"If you have your cardiac surgery in Glasgow you go back to a fourth-floor tenement flat in Shettleston."

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Dr John Garner, chairman of the British Medical Association in Scotland, also warned against further reductions in the number of beds, explaining a large proportion were needed for emergency admissions.

And Margaret Davidson, of the Scotland Patients’ Association, condemned Gregor’s suggestion that some local hospitals should be allowed to close.

However, the Scottish Executive said it welcomed Gregor’s comments and shared some of her views.

A spokesman said: "Bed numbers should not be the currency on which we judge the success of the NHS.

"What is far more important is to look at the patient and how their journey of care through the system is managed."