Debate is needed but the NHS must change with times

by Dr PHILLIPA CURRAN There has been a lot of debate in the pages of the Ham&High recently about local health services. As a local GP, I welcome such debate. I have been looking after people in Barnet for 30 years and, as much as anyone, I understand why people are so loyal to

There has been a lot of debate in the pages of the Ham&High recently about local health services. As a local GP, I welcome such debate. I have been looking after people in Barnet for 30 years and, as much as anyone, I understand why people are so loyal to their local health service.

I actually trained to be a doctor at Guy's and St Thomas' Hospital in the early 1970s. Things were very different. Heart transplants were still pretty new and the first 'test tube baby' only happened in 1978.

It all seems a very long time ago. But health has since moved on a great deal and, just like the way we used to live, I have to say I for one am rather glad for the change.

Back then, we had no breast screening, no organ donor programme and no walk-in centres.

We drove around in large and often ugly cars and ate more and more convenience food. We even used to get excited about a powdered potato product called Smash!

Why am I telling you all this? Well, a lot of people locally - including many who have been going to their GP since the 1970s - are worried about the future of the NHS.

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News has emerged of a review of services across an area called 'North Central' London, which includes the boroughs of Barnet, Enfield, Haringey, Camden and Islington.

Barely eight months since the bid to change services at Chase Farm was unsuccessfully challenged in the High Court, it seems we could once again be consulting on service changes at hospitals across North London.

Not surprisingly, there have been fresh calls for hospitals to be saved. MPs have been placard-waving and former hospital chiefs have warned that London could end up with only one giant hospital.

We even had one correspondent in this newspaper fondly recalling the 19th century Coppetts Wood Hospital for hazardous infections.

As I have said, this is all a very important and worthwhile debate. However, it is also really important to make sure we are talking about the same things.

Take the phrase "local hospital". Some, including local MPs, have taken this to mean a hospital without any A&E care. If the Whittington becomes a local hospital, it will lose its A&E and effectively become a non-hospital, or even close completely, according to them. This is quite wrong. As the very clever surgeon and former Health Minister Lord Darzi has made clear, a local hospital can have anything from a full A&E with an intensive care unit, to an urgent care centre, open 12 hours a day.

Equally, MPs and others have referred to hospitals with full A&E departments as though those are the only 'real' hospitals worth having - as though all the other types of hospital and hospital departments don't really matter.

Caroline Cook, who wrote so movingly in your newspaper in an unconnected article about her treatment at the Whittington, was talking about treatment for breast cancer - which, though equally urgent, is delivered in a completely different department to the A&E.

She doesn't feel safe whenever she returns for check ups at the Whittington because it has an A&E, but because it is a good hospital. The two are not mutually exclusive.

Now, I don't blame people for being worried about the future of a great institution like the NHS, or worried about hospitals which have cared for them. In the current economic climate, keeping existing services running is going to be challenging enough, let alone while we are also designing newer, better services.

No, I like people to be passionate about the NHS. I am. I do also like people to try to appreciate that those of us who live and breathe medicine are genuinely trying to keep it relevant and up to date, to think of new ways of delivering care, to be prepared to move services around - including A&E departments - if it makes more sense and it is arguably safer to have them in one location over another.

This is particularly critical in London, where the population and the needs of this great metropolis are in a constant state of change and flux.

We medical practitioners have to adapt to this change, if we are to treat our patients as successfully as possible. We have to move on, learn new skills, read about new treatments, deliver care in new ways.

So, let's by all means talk about the future of health services, but let's also take as our starting point that they do actually need to change. Medicine does not stand still from one year to the next, let alone between decades.

After all, no-one would seriously expect a hospital to stay exactly as it was in 1973, just as hardly anyone these days voluntarily eats powdered potato.

Dr Philippa Curran is a a Barnet GP and chair of the Clinical Advisory Group for the North Central London review

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