The Department of Health's Configuring Hospitals in Health and Social Care project was set up to assist health communities in finding new solutions that fit with the modernisation agenda, meet technological, staffing and other challenges and command local support.
Keeping the NHS local
- focus on redesigning services, rather than relocating them
- take a whole systems view
- develop options for change with public and patients, not for them
The project has focused on small hospitals, which are 'feeling the pinch' from the centralisation of acute and specialist services and the development of new, ambulatory care models. It outlines a number of models to help them 'bridge the gap.'
The framework is not a detailed manual for change and does not provide a template for future service provision. It is intended to stimulate debate.
Signposting the future
It is impossible to say what the future will look like, but the framework picks out some key trends for the next twenty to thirty years. This includes: aging population, rising public expectations, expanding medical knowledge, medical technology advances and ability to provide care in new settings.
Why services may need to change
- Meeting patient needs: reconfiguration presents an opportunity to reshape services around the needs of patients today
- Safety, quality, practicality: there may be a tension between delivering specialised services locally and conveniently and delivering them in centres of excellence
- Staffing: staffing pressures are being intensified by the contracting workforce pool and implementation of the European working time directive
The emphasis is on redesigning not relocating services particularly in small hospitals. Smaller general hospitals have been particularly exposed to the quality and staffing pressures identified above. At the same time, they have been caught between two trends, pulling in opposite directions. Acute and specialised care has been increasingly centralised, while new models of 'ambulatory care' have been developed. Smaller general hospitals still have a vital role to play in 'bridging the gap' between the two.
Following the route map
In the new planning route map, health communities are guided through each of the six stages:
- Stage 1: beginning the process
- Stage 2: developing a whole system vision
- Stage 3: defining the limits of the possible (service redesign, workforce redesign and use of technology
- Stage 4: options for change
- Stage 5: identifying the best option
- Stages 6 and 7: implementation strategies
New models of care
As a minimum, it says, smaller general hospitals should provide a 'first port of call' - they should be able to receive and assess patients, provide initial treatment and arrange for treatment when necessary.
This will only work if hospitals work in partnership with their surrounding primary care team and neighbouring hospitals, often using IT links. The framework sets out some emerging models:
- Emergency medical and surgical care, within constrained staffing resources: In this model, there is 24-hour access to emergency medical and surgical care, delivered by relatively small numbers of staff, supported by primary care and links to larger, acute and specialist services. (Central Middlesex)
- Emergency medical care and elective surgical care: In this model, accident and emergency services and emergency medical care is delivered without 24-hour, resident surgical cover. This relies on effective joint working with sites where this cover is available (Bishop Auckland)
- Local acute emergency assessment: In this model, patients receive rapid assessment at a local unit. Patients requiring intensive, acute care are then transferred to a larger site for direct admission to the wards. This relies on telemedicine links to the larger site and good transfer arrangements. (West Cornwall Hospital in Penzance).
Future Capacity Requirements
Bed requirements - The NHS is using its beds much less effectively than Kaiser Permanente, a Californian health maintenance organisation. This is described in a BMJ article with Chris Ham's analysis of the use of beds by Kaiser Permanente. BMJ Volume 327, Number 7426, Issue of 29 Nov 2003 - NHS makes bad use of acute beds
Patient Flows - this article describes the work of the Intensive Care Society and Department of Health Working Group on Patient Flows: Capacity in Critical Care
As FHN is now closed, these pages will no longer be updated.
