The Naylor Report: the danger that lies ahead

By Bernadette Meaden
June 1, 2017

For many years I have been under the care of the Royal Brompton Hospital in London. It is part of the Royal Brompton and Harefield NHS Trust, the largest specialist heart and lung centre in the UK, and among the largest in Europe. Each clinic visit or admission involves a 400 mile round trip, but I travel happily, grateful for the outstanding care available at the Brompton.

The heart condition I was born with is so rare many doctors have never seen a patient with it – on one occasion, when being transferred to the Brompton from a local hospital, the doctor accompanying me cheerfully admitted that when I arrived at A&E, “we had to get the text books out”.

At the Brompton, I’m just one of many patients with rare congenital heart conditions who have been safely nurtured into adulthood (and middle age), thanks to pioneering surgery, procedures and medical treatments. Over the years, each time a crisis occurred, the brilliant staff at the Brompton came up with another option which saw me through, as they have done for countless other patients. And they do it not just with great professionalism, but with care and kindness.

This is all made possible due to a remarkable concentration of skill, knowledge and expertise from around the world, attracted by the hospital’s excellent international reputation and world-leading research.

So it was something of a shock, to say the least, when NHS England announced that it was going to withdraw congenital heart disease (CHD) services from the Royal Brompton. As Robert Bell, the Hospital Chief Executive said, “If this plan were to be implemented, not only would 12,500 patients have to be added to the waiting lists at other centres, but the knock-on impacts would be disastrous for other services. For example, our children’s paediatric intensive care unit is also part of the closure plan, and without that we would be unable to care for the children who come to us with serious respiratory diseases such as cystic fibrosis, severe asthma and muscular dystrophy. The effects on our congenital heart disease research programmes would be nothing short of catastrophic.”

It seems that in order to justify this closure, NHS England has decided to hold the Brompton to a standard which is impossible for it to meet. In a review of CHD services the Brompton was found not to meet a new standard, that of ‘co-location’. This requires certain paediatric services – gastroenterology, nephrology and general surgery – to be permanently ‘co-located’ in the same building as the CHD service. As Royal Brompton is a specialist heart and lung hospital, these additional services are based at the neighbouring Chelsea & Westminster Hospital, a few minutes walk away.

Staff from the two hospitals have worked together for years under a formal Service Level Agreement, with joint rotas, ward rounds, meetings and shared systems. The Trust has a 100 per cent record of ensuring that any patient in need of these additional services receives them, whenever they are needed, day or night. I can testify to how well this co-operation works, having benefitted myself last year. There is no evidence that Trusts which do have ‘co-located’ services have better patient outcomes than the Brompton.

So it would seem that on a geographical technicality, NHS England is preparing to wreck a real jewel in the crown of the NHS. But then, perhaps geography is not a technicality - perhaps geography is the key.

The Brompton is located in a very desirable area of Central London, just off the Kings Road in Chelsea, with entrances in Fulham Road and Sydney Street. Flats and houses in the area currently sell for several million pounds each.

And perhaps this is where the Naylor Report ‘NHS Property and Estates’ comes into play. Commissioned by Jeremy Hunt and published in March 2017, Theresa May has already given it her backing. The review’s purpose was “to develop a new NHS estate strategy”, to sell off and redevelop NHS land and property.

One of the most remarkable recommendations in the report is that the Treasury ‘should provide additional funding to incentivise land disposals through a '2 for 1 offer' in which public funds match disposal receipts.’ This seems to be a huge incentive to sell public assets at below market value to the private sector. Perhaps that is why the report has been condemned  by the National Health Action Party as a plan for a “a mass transfer of assets on the cheap from the public sector to private hands”,  but welcomed by property developers and international lawyers. NHS Trusts which don’t sell off assets will be financially penalised.

In the context of closure plans like those at the Brompton, alarm bells inevitably start to ring. The Naylor report says that property worth £2.7 billion could be ‘released’, but “this estimate could rise significantly if the NHS adopts a more commercial approach to obtaining planning consent, negotiating affordable housing quotas and maximising value from the highest value sites in London.” (my emphasis)

I sincerely hope I’m wrong, but I fear that the Department of Health may be planning to run down a world renowned centre of excellence because the land it stands on is valued more highly than the supremely humanitarian values it represents and puts into practice every day. That really would be knowing the price of everything and the value of nothing.

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© Bernadette Meaden has written about political, religious and social issues for some years, and is strongly influenced by Christian Socialism, liberation theology and the Catholic Worker movement. She is an Ekklesia associate and regular contributor. You can follow her on Twitter: @BernaMeaden

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