Rapid Responses to:

LETTERS:
Patrick M Trust
Reconfiguration of surgical, emergency, and trauma services: Patient power may be the way forward
BMJ 2004; 328: 522-c-523-c [Full text]
*Rapid Responses: Submit a response to this article

Rapid Responses published:

[Read Rapid Response] Letting the Public Decide
Peter A West   (2 March 2004)

Letting the Public Decide 2 March 2004
Top
Peter A West,
Director, York Health Economics Consortium
Market Square, University of York, York YO1 5NH

Send response to journal:
Re: Letting the Public Decide

I wonder how your readers, whether in favour or against greater public power in determining hospital service locations, would react to the following real life example. When I was working on the planning of a new cancer centre, with oncology and two linear accelerators, to serve a population with existing access to two other cancer centres, it emerged that two consultants in a smaller hospital, about 50 miles away from the proposed centre, were already doing some oncological work. This had attracted the interest and support of local people and there was a fund- raising campaign to buy a linear accelerator, even though it was clear that this smaller hospital was not a suitable location for the main cancer centre, due to its relative remoteness from the main centres of population. Should cancer services proliferate according to local public concern and fund-raising? Should the NHS be prepared to take on the costs of operating such services, whatever their fit with its own plans? Should the NHS, with appropriate high level advice, determine the services provided to a local population. Or should this be in public hands, bearing in mind that the "public" will in fact comprise a small group of activists and a wider group who might be influenced by some or all the evidence put forward. Given the very limited information on the real adverse effects of travel to distant hospitals on patient outcomes, do we want the public to determine what (probably or perhaps possibly) works best or the professionals?

Competing interests: YHEC Ltd undertakes research for the pharmaceutical industry, the Department of Health and the NHS. No current work is underway on the location of hospital services but research is planned on the evidence base for the Golden Hour.