In The Comedy of Errors, Shakespeare explores the mishaps that arise when people are misled by their own eyes. Labour's standing on health will soon fall victim to some major mishaps of its own, unless the government can explain to voters why what they see happening is not all it seems. For, as yesterday's Guardian reported, the new NHS chief executive, David Nicholson, is planning a rationalisation that could involve closing or downgrading A&E and maternity units up and down the country. Convincing people that the NHS is improving whilst this is going on will be tough indeed.
Trends in medical technology point in two opposing directions when it comes to the appropriate pattern of healthcare. On the one hand, some therapies that used to require an in-patient stay can now be delivered at home or by the GP. On the other, some high-tech treatments are best provided in specialist centres with a concentration of expertise. Caught in the middle are traditional, district hospitals, whose relative importance diminishes.
Thus there can be a strong efficiency case for closing or merging services, but doing so involves genuine inconvenience for some patients and big political costs. In 2001 Labour lost Wyre Forest to an independent candidate protesting at the closure of Kiddiminster hospital's A&E. More recently, plans to merge Huddersfield and Halifax maternity units have caused uproar. In Scotland - where "reconfiguration" is more advanced than England - the furore around another A&E closure was such that cabinet minister John Reid felt obliged, as the local MP, to join in with the protests.
The government openly raised tax by £8bn to fund the NHS, and waiting lists are lower and cancer and cardiac survival rates far higher than they were. But, other than the minority who have ongoing personal contact with the service, voters will not believe such claims when all they hear of locally is cuts. Reconfiguring as many as 60 NHS trusts ahead of the next election could render Labour's NHS trump card a huge liability. The right response is not to ditch all the changes, but to pace them carefully and undertake real consultation to identify and address the most pressing local concerns. Minister must be seen to do all they can to avoid unnecessary closures. They will be harder to defend where they come alongside expanded private provision - especially when evidence on the value that this offers is shaky. It will not be easy to reconsider such a totem of reform. But getting people to disbelieve their own eyes requires nothing less.
