Not needlessly doing things umpteen times is an important thread in improving healthcare peformance and productivity. And so it is preached that much work can be consolidated across the organisations doing it. This can be applied to frontline services and to support services - but there are separate issues.
For frontline services, the benefits of consolidation are primarily those of quality and safety. For example, having fewer centres offering specialised cardiac surgery for children is considered necessary, so that the relatively small numbers of skilled specialists can gain the range and volume of experience that they need. As an informed society, we are prepared to trade in ease of access to a local facility, so that we secure the best care to which we are entitled. And it is achievable, because the costs saved by closing some centres can be re-invested to expand, equip and staff the remaining ones. Some other services are harder to attract public support, even though the arguments are the same - for example, reducing the numbers of maternity units or A&E departments.
For support services, the benefits of consolidation are commonly financially driven. Many of the quality/safety benefits may also apply - less significantly in admin back-office functions, much more so, however, in clinical support services. Indeed, there are real issues with consolidating diagnostic services. Access to these capabilities is of front-line-like value to patients, and access by requesting clinicians is also of concern. However, does every hospital really need the high capital and staffing costs of running its own radiology and pathology services? After all, their costs continue to escalate owing to scientific advancement, and the highly skilled staff are not always available in sufficient numbers.
One way to exploit the benefit but avoiding the pitfalls is to separate out two facets of these services: the PRODUCT, and the SERVICE. The product might be a test result, or a PACS image. The service is the value added to a clinical process, that is created by interpretation and then relevant application to each patient's needs. Clearly, each hospital needs a pathology service and a radiology service - as, indeed, does every GP. But do they each need their own capacity to perform the tests or the scans?
The benefits of consolidated production are considerable, potentially. It can allow local "non-production" clinical leads to focus on service, and not worry about the operational day-to-day issues of running a lab. It can allow for a far higher degree of choice - for example, GPs able to secure best value radiology services from alternative providers. However, to realise that potential requires care: to preserve information flows that avoid duplication of work, or to ensure that common technical and medical standards apply to different labs working in a single network.
There is a lot of consolidation being planned and implemented, as the savings to be made are huge (half a billion pounds per year in England alone, from consolidating pathology services - was made for DH by the Carter Committee). In addition, however, if done right, the gain in service value is also considerable. Can this be a win-win?
Yes it can BUT only by retaining and extolling the local experts who can then focus upon the SERVICE. Rather than feeling loss of status through the production being moved elsewhere, the clinicians who stay to offer the service are the ones in whose hands the real benefits will be safe.
