Hospitals need to change, the King's Fund says Government plans to give more power over NHS decision making in England to GPs could make much-needed hospital reform difficult, a think tank says.
The Kings Fund says a major shake-up in hospital services is essential to make care safer and wants services such as maternity and A&E run from fewer site.
It says GP consortia will not have the strength to make strategic changes.
But the Department of Health said the plans would strengthen the ability of the NHS to make the right decisions.
A spokesman said: "We urgently need to modernise the NHS - that is why our plans include many measures to make services more responsive to patients and to consistently drive up quality."
The Kings Fund came up with its conclusions after analysing the handling of an overhaul of hospital services in south-east London.
Under the changes - or reconfiguration as it is called within the NHS - specialist services are being concentrated on fewer sites.
But they are only happening after one hospital was forced to close its A&E and maternity units because of safety fears.
Changing hospitals - and in some cases closing parts of them - is the elephant in the room no-one dares talk about.
It is just too controversial. Hospitals are the visible face of the NHS and unsurprisingly people feel great affection for them. So when a particular unit is under threat they start to protest.
This has left many worried about putting the case for change - hence the ambiguous phrase the NHS uses to describe the process, reconfiguration.
While many experts say it is inaccurate to say hospitals will close, the experience in south-east London as set out by the King's Fund shows that at the very least some services do.
Surgery, A&E, obstetrics and paediatrics all ended up on fewer sites following the changes.
The King's Fund said similar changes were needed elsewhere because of the funding squeeze.
The government has protected the NHS budget by giving it small above-inflation budget rises over the next four years.
But the report said it was still entering a "cold climate" because demands and costs were outstripping the settlement.
It said without change there could be a "downward" spiral of falling income, growing deficit and declining quality.
Scandals such as Mid Staffordshire, where an official report found hundreds of patients died needlessly because of poor care, could not be ruled out.
But the King's Fund raised concern over whether the NHS was going to be able to ensure the right change took place.
It said one of the lessons of its analysis of south east London was that strong management was needed to make the right decisions.
But it warned the forthcoming creation of GP consortia, which will see two layers of management scrapped, meant it was unlikely successful change will take place.
Nigel Edwards, of the NHS Confederation, which represents hospitals, said he agreed with the findings.
"There has been too much procrastination for too long on a number of outstanding reconfiguration plans where the case has been made," he said.
British Medical Association's consultants committee chairman Dr Mark Porter said change was necessary, but it needed the backing of doctors.
"We agree that hospital services cannot stand still," he added.
This article is from the BBC News website. � British Broadcasting Corporation, The BBC is not responsible for the content of external internet sites.
Source: http://www.bbc.co.uk/go/rss/int/news/-/news/health-12620084
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