Improvements or cuts? Restructuring of the NHS can't be done on the cheap

The SNP lost its second vote in the chamber since losing its overall majority this week.

The debate was on local cuts to NHS services. It was a Labour motion. 

Health board moves to consolidate services and beds are being resisted by people, and Labour brought it to the parliament, calling for the decisions to be defined as 'major service changes', meaning they would need the approval of ministers.

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This is interesting, because the SNP came to power in 2007 on the other side of this very argument, opposing Labour-led NHS centralisation. 

Both administrations have taken the same advice of course, which shows that centralising clinical speciality is evidence-driven, and drives up quality.

However it isn't the whole picture. If the patient voice is to be listened to, as a truly person-centred system should, then the location and provision of services is part of that.

The further specialist services are from where you are, the less they feel they are for you. My local A&E was closed, so in an emergency I now need to travel 15 miles along an a-road to get myself stitched back together.

Furthermore, the National Clinical Strategy clearly states centralisation must be balanced with local beds in small rural hospitals and in community settings.

Without significant investment in these alternatives, moves by health boards to consolidate local services should be viewed for what they are: cuts, driven by squeezed budgets and demands for efficiency savings. 

I visited the practice nurse at my GP surgery this week, and she told me the pressure on staff to cut costs had "gone far, far too far" and she and her colleagues in primary care "were very concerned about quality".