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3 June 2014
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A local health service?

NHS England chief executive Simon Stevens’ call for less centralisation may be supported by many in the sector, but we’ve heard this talk before
In an interview with the Daily Telegraph recently, NHS England’s new chief executive Simon Stevens called for a move away from the “steady push towards centralisation” of recent years in favour of more services being provided from local and community facilities.

While those in the partnerships industry may welcome the idea of moving more work from acute hospitals into primary care – where new buildings may well be needed to house such work – the idea is nothing new.

Take, for example, Stevens’ suggestion that GPs and hospital specialists should work together within communities. I have a word for such buildings: polyclinics.

Unfortunately, that word probably won’t be picked up if Stevens’ ideas get traction, because those of you with (not too) long memories will remember that ‘polyclinics’ were meant to be Labour’s solution to the creeping march of centralisation. Then-health minister Lord Darzi was meant to oversee their roll-out across the country.

Indeed, the polyclinic idea was supposed to be the logical progression of the Lift programme, with the Express Lift initiative set up to get primary care projects delivered at a faster pace.

For a variety of reasons, though, the polyclinic idea never took off to the extent that Lord Darzi had envisioned. Instead, we find ourselves today in much the same position as when he was in government, with only a few examples of community-based clinics dotted around the country as evidence of a quickly abandoned attempt to change the status quo.

So while the idea of more services being transferred to local hospitals, polyclinics (no doubt under some other name) or ‘community’ facilities does seem sensible – not least because it will take pressure off some overworked acute hospitals – making it happen will be a different matter. Some sources suggest new hospitals have occasionally been pushed through in the past by politicians keen to have something to show off to their constituents, simply because a neighbouring MP has just opened their own hospital.

And evidence shows that people remain wedded to A&E facilities in particular, and will often fight tooth and nail to prevent them being removed or downgraded. Twelve months away from an election, it is a fight few politicians will want to take on.

The good news is that there are at last some signs of movement in the primary care sector, with the prospect of some more deals making it to market over the coming year after the delays caused by May 2013’s NHS reorganisation. Whether a grassroots development of new infrastructure, led by local clinician groups, can achieve what top-down reorganisation has so far failed to do remains to be seen.

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NHS England chief executive Simon Stevens’ call for less centralisation may be supported by many in the sector, but we’ve heard this talk before

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