Leader comment: Hospital closures must not increase risk to the vulnerable

The closure of a public service facility is almost always a matter of controversy and regret, particularly if the cause of loss is a lack of sufficient resource to maintain viability.

Experience shows us that when a facility goes, it is unlikely to return any time soon. Take, for example, the railway lines and stations which were removed from the network in the 1960s and 1970s, many of which remain sorely missed. It is far easier to close than to re-open.

In that knowledge, the Royal College of Physicians of Edinburgh (RCPE) is unlikely to have come easily to the conclusion that, if the health service is to make the best use of limited resources, it may be prudent to close some hospitals and centralise services.

For those who use these facilities and services, such a suggestion can be alarming. No-one wants to have to travel further for treatment than they already do, and no-one wants to lose a community facility which has been relied on for generations.

But it makes sense to consolidate services, both in terms of available resources and modern-day requirements. A cottage hospital which was most effective in its community several decades ago can look more like an anomaly in 2017. As the RCPE has noted, there are concerns that some facilities have been kept open not to provide effective care, but to prevent the backlash that closure would cause.

We have seen recent evidence in Scotland of the strategy suggested by the RCPE, with a move towards specialist centres, and we can expect to see further re-allocation of resources based on population counts rather than geographical spread.

This will give rise to concerns from rural communities, where accessing a centralised service could involve a lengthy journey. There have already been protests over the downgrading of maternity services at Caithness General in Wick, with women at risk of birth complications now having to travel 100 miles to Inverness.

It is in these such areas where exceptions will have to be considered, if the strategy is to work. The more distant a service, the greater becomes both the inconvenience and the risk.

Consolidation is taking place in many industries at the moment, but if this strategy is to succeed with health services, in certain areas it will require to be done with more than just the balance sheet and size of population in mind.