Sir, – Despite a miasma of assurances from ministers that major decisions affecting the NHS are to be taken at local level after full consultation, it is becoming transparently obvious to a concerned and sceptical British public that we are witnessing a succession of centrally-driven reconfigurations marking milestones on the road to a service which will eventually be provided almost wholly by the private sector. The phrase that "care will continue to be provided to the patient free at the point of need" barely conceals an emerging long-term strategy that appears willing to promote privatisation over principles of health gain, clinical safety, equity, accessibility, accountability and value for money to the taxpayer. Each of these important principles risks being eroded on the basis of scant evidence to support the introduction of privately provided, independent, sector treatment centres for elective treatments, and emergency urgent- care centres and critical-care units. Indeed, where is the evidence that this direction of travel will improve the health of the nation and promote a safe, efficient and accountable health service? On the basis of "commercial confidentiality", the parliamentary health select committee has so far been denied access to a detailed audit relating to the performance and value for money of the independent centres already in place. Nonetheless, these unproven reconfigurations continue to be driven through on terms favourable to multinational organisations which, even when these organisations under- perform, are contractually guaranteed a fixed annual income. Note that, this year, one third of primary care trusts are putting GP services out to private tender and that a number of companies are poised to enter the market. It is widely concluded that downgrading excellent local district general hospitals by removing A&E facilities will inescapably damage the health of the population and the local economy. The compensatory mantra, "bringing care nearer to the patient", has a hollow echo, especially should an option be offered such as a privately-run emergency care centre (not equipped for major emergencies) traded for a critical care unit up to 20 or 30 miles distant. Given distances and ambulance response times to some areas, the "golden hour" following a life-threatening situation slips away. The call for retaining full- scale emergency services closer to the patient carries a weighting that politicians ignore to their cost. Many hospital consultants and GP practices in this strategic health authority (SHA) area have made their views known to their primary care trust (PCT) in a cogently-argued case to maintain A&E services within the district general hospital. Thousands of members of the public have written letters and signed petitions to the SHA and their PCT's (see http://www.savetheroyalsurrey.org">www.savetheroyalsurrey.org and http://www.supportstrichards.co.uk">www.supportstrichards.co.uk). Do the views of professionals and public matter? What steps must the decision-makers take in the planning stage? We should be aware that, before making decisions affecting the provision of health services, it is the legal duty of NHS bodies to consult the overview and scrutiny committee of the county council. NHS bodies must involve and consult service users and potential service users. If dissatisfied, the overview and scrutiny committee can require an officer from those holding the major part of the budget on behalf of patients (the primary care trust) to attend a meeting; the committee is able to report to the Secretary of State requesting further consultation and can request that the Secretary of State overrules the decision of the local NHS body. Department of Health Guidance states that: "Section 11 places a wider duty to involve and consult patients and the public: not just when major change is proposed, but in the ongoing planning of services: not just when considering a proposal but in developing that proposal; and in decisions that may affect the operation of services." (Strengthening Accountability – Involving Patients and the Public, Health and Social Care Act, 2001). May we reliably assume that the elected members of the local health overview and scrutiny committee will represent the views and wishes of the constituency they serve? The process of consultation has yet another layer, closer to ministers and the Department of Health: the Independent Reconfiguration Panel. It is to this group that the Secretary of State for Health has referred on a number of occasions. Primarily, this panel is mandated to provide expert advice on contested proposals and options for NHS reconfigurations. However, alongside its policy of "equality of access to advice", the panel is open to receiving comments. Your readers may wish to consider sending copies of their letters (namely, those already written to their MP, the strategic health authority, the primary care trust, or to your newspaper, for example) as information to: The Chairman, Independent Reconfiguration Panel, Kierran Cross, First Floor, 11, The Strand, London WC2N 5HR. Jacqueline Kennett, Henley, Haslemere
