Observations Life and Death

Falling through the gaps in care

BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e7863 (Published 21 November 2012) Cite this as: BMJ 2012;345:e7863
  1. Iona Heath, retired general practitioner, London
  1. iona.heath22{at}yahoo.co.uk

The gap between hospital and home is unsustainable and, for the sake of our frailest and most vulnerable patients, must be closed

The stresses of yet another reorganisation of the NHS, combined with the Nicholson challenge of achieving £20bn in “efficiency” savings by 2015, are widening pre-existing faultlines at an alarming rate. Patients are already falling through the resulting gaps and seem likely to do so in increasing numbers unless those in power are prepared to make the necessary effort to understand more clearly what is going on and to stop fiddling while the NHS burns.

There are gaps between specialists and generalists, between the provision of physical and mental healthcare services, and between financial and clinical imperatives, but perhaps the biggest gap exists between two different sorts of bed, the one in hospital, the other in the patient’s own home. Services have become ever more centralised in large hospitals as a direct result of the trend to increasing specialisation among hospital doctors, combined with the evidence that, for patients lucky enough to have only one condition, care in a specialist unit provides better outcomes. …

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