Internet surveillance and NHS reconfiguration: making today’s news

It can take years for a story to go from being something that ‘everyone’ knows, to becoming today’s news. I was writing about government internet surveillance a decade ago, and was hardly the first. (The online world is not built for secrecy.) The piece comes from a 2002 Guardian supplement that also included a piece on how tabloid newspapers gained illegal access to personal data, including through police officers. But again, that story didn’t take off until the Guardian fingered the News of the World over Sara Payne’s voicemail in 2011. It takes a long time to get to critical mass.

At the NHS Confederation conference last week, you could see another story that, probably, will some day become today’s news. It’s almost a cliché among professionals that the NHS needs have fewer, bigger specialist hospital units, known in the health service by the code word of ‘reconfiguration’. Such units tend to have better results (as in, more patients survive), be more sustainable (it is easier to attract highly-skilled medical staff, who would rather work in centres of excellence than in outposts) and be more efficient. But because this means closing smaller units, such plans are often politically toxic, such as with child heart units.

Last Wednesday, reconfiguration got attention when the NHS Confederation, Academy of Medical Royal Colleges and patient group National Voices published a report arguing for it, which got wide coverage including on the front page of the Times. But the political problem with it being accepted was nicely illustrated by health secretary Jeremy Hunt in his Confed speech the next day. He supported reconfiguration by quoting its best-known justification, that of stroke treatment in London, where replacing 32 units with eight has greatly improved survival rates. But he had to admit that he was one of the many local MPs who has campaigned for his local hospital to retain services (covered by Health Service Journal).

Sir David Nicholson’s final speech to Confed as NHS chief executive was reported as attacking the coalition. He did, a bit, but that was hardly his main target: he spent more time complaining about the tyranny of the electoral cycle, stopping needed decisions in the year or two before the general election; and, more generally, how both politicians and  managers have to argue for NHS reconfiguration. He said that everyone who understands the reasons, particularly trusted figures such as senior health service staff, should argue for such changes. But he’s done so before, and it remains a politically controversial view.

It may be that, after some scandal, the nation’s view will flip and it will become commonplace to argue that specialised hospital services should be consolidated in fewer locations. Media organisations will ask why this wasn’t done years ago. (Partly because of those organisations, will be the answer. Sir David said he resigned partly because he was being hounded by the media.)

For now, while the benefits of NHS reconfiguration may be obvious to those at Confed, the fact that it isn’t happening isn’t yet today’s news.