NHS cuts: a need to be clinical?

The right of challenge

The financial pressures on the NHS have never been greater. In 2010, the NHS was plunged into a ‘decade of austerity’ leading to concerns over patient welfare, concerns which, sadly, have often been realised.

Against this backdrop, it is imperative that local health boards and other NHS bodies are not tempted to cut corners and push through unlawful decisions in the interests of saving costs. For instance, decisions to ‘centralise’ regional patient services must be properly consulted upon with clinicians and members of the public alike, to ensure that patient welfare is not compromised.

Judicial review is a process by which such unlawful decisions can be challenged in court and, if successful, the decision nullified.

Clinical input

It is often the affected public via action groups that raise the alarm about suspect decisions regarding patient services, but they should not go it alone.

Decisions regarding health services are inextricably linked to patient welfare and clinical performance. Those factors are often impenetrable by the local population affected by the decision, which puts them at a distinct disadvantage in seeking to challenge the decision. This can be overcome by working closely with the local clinicians and healthcare professionals to carefully co-ordinate a response.

The combination of the interests and knowledge of the local public and the medical staff will make it possible to take a balanced and informed view of the decision and the basis upon which it was reached. Without this dual approach, it is easy to see how any such challenge to the decision can be stifled by facts or circumstances beyond the knowledge of the challenger.

Experience shows

In a recent successful judicial review challenge against Betsi Cadwaladr University Health Board’s decision to temporarily close part of its maternity services, we witnessed the benefits from such an approach. The dissatisfaction and concern demonstrated by the local public in that case along-side the detailed and expert knowledge of the local clinicians proved a very powerful force; it ensured that all grounds put forward to justify the decision were able to be scrutinised in depth. The key was in coordinating those views. In this case the BMA provided an invaluable role in aligning those interests to enable a proper assessment of the decision and, ultimately, a warranted challenge.