This report by the Press Association comes from The Nursing
Times – it’s a report by The Royal College of Physicians on their view of the future direction of the NHS.
If I’ve got time I’ll try and check out the original report.
However, while there are some really good suggestions, the
reorganisation that is being proposed is also designed to save money.
The suggestion that there should be small, local acute units is
particularly irritating. For many years, local campaigners fought hard (unsuccessfully)
to save small, local hospitals which were closed wholesale over the last thirty
years…on the basis that economies of scale would save money and improve
outcomes.
Now the big idea is to save money and improve outcomes by closing big hospitals and opening up small local ones. Sigh.
Medical
college report calls for seven-days-a-week hospital care
12
September, 2013 | By The Press Association
Hospitals
must be reorganised so patients do not have to move beds or wards unless
medically necessary, a new report says.
Care must
also be provided seven days a week, with full access to scans and lab testing
even at weekends.
The study,
from a commission set up by the Royal College of Physicians (RCP), makes 50
recommendations on the future of NHS hospital care.
It says a
rise in admissions and more older patients with complex needs means “hospitals
are struggling to cope”, while units are not equipped to provide excellent care
on weekends.
“All too
often our most vulnerable patients - those who are old, who are frail or who
have dementia - are failed by a system ill-equipped and seemingly unwilling to
meet their needs,” the report said.
It is not
unusual for patients to move beds several times during a single hospital stay
which “results in poor care, poor patient experience and increases length of
stay”.
The study
said that, in the future, moves between beds and wards will be minimised. “Once
admitted to hospital, patients will not move beds unless their clinical needs
demand it.”
And the
authors call for a shift to seven-day working, with consultants having a
presence on wards and the full range of tests available every day of the week.
Several
studies have shown that patients admitted to NHS hospitals at weekends and on
bank holidays have higher death rates and poorer outcomes.
The report
said: “Acutely ill medical patients in hospital should have the same access to
medical care on the weekend as on a week day.
“Services
should be organised so that clinical staff and diagnostic and support services
are readily available on a seven-day basis.
“There will
be a consultant presence on wards over seven days, with ward care prioritised
in doctors’ job plans.
“Rotas for
staff will be designed on a seven-day basis, and co-ordinated so that medical
teams work together as a team from one day to the next.”
Under the
plans, arrangements for discharging patients from hospital will also operate on
a seven-day basis, with closer links with community services and social care.
The report
comes from professor Sir Michael Rawlins, chairman of the Future Hospital
Commission which was established by the RCP last year.
It
acknowledges that “tough decisions lie ahead” including the reorganisation -
and possible closure - of existing services.
“Reconfiguration
will almost certainly be needed,” it said. “No hospital can provide the range
of services and expert staff needed to treat patients across the spectrum of
all clinical conditions on a seven-day-a-week basis.”
The study
calls for a new model of “hub and spoke” hospital care.
“It is
likely that in many areas, large health economies will be served, not by a
number of district general or teaching hospitals, but by a smaller number of
acute general hospitals hosting emergency departments and trauma services,
acute medicine and acute surgery.
“These
hospitals will be surrounded by intermediate ‘local general hospitals’ which,
while not directly operating their own emergency department and acute admitting
services on site, will contribute to step-down inpatient and outpatient care,
diagnostic services and increasingly close integration with the community.”
Sir Richard
Thompson, president of the Royal College of Physicians, said: “This is a once
in a generation opportunity to improve the way that we care for medical
patients.
“When I set
up the Commission in March 2012, it was intended to review all aspects of the
design and delivery of inpatient hospital care, and to make recommendations to
provide patients with the safe, high-quality healthcare that they deserve.
“It has
done much more than that. The Commission brought together patients and medical
and healthcare experts to develop a vision of the future hospital, a hospital
which is no longer bound by its walls, but reaches out into the community to
care for medical patients.”
The report
said effective alternatives to hospital admission must also be found, including
better managing people in their own homes or other community settings.
And it
calls for all doctors to feel responsible for the quality of basic care given
to patients - for example hydration - and “take action whenever they become
aware of this being inadequate”.
New roles
will be created in hospitals, according to the proposals, with a chief of
medicine having ultimate responsibility for all adult patients and a new “buck
stops here” approach.
A new chief
resident will work with junior doctors and help plan service design and
delivery, including rotas, duties and workload.
The report
said care should be organised so patients are reviewed by a senior doctor as
soon as possible after arriving at hospital, and should see a specialist in
their condition as soon as possible.
This might
mean seeing multiple specialists for some patients, with care co-ordinated by a
single doctor.
An “acute
care hub” in the hospital will focus on accommodating patients for up to 48
hours and consultants from a range of specialties will spend time here to offer
expert opinion.
A separate
“clinical co-ordination centre” will act as a control room for real-time
patient information, handover and transfer briefings, and organisation of care
for all acutely ill medical patients , whether inside or outside the hospital.
Dr Cliff
Mann, president of the College of Emergency Medicine, said: “This report has
major implications for emergency medicine. The emergency department is reliant
on comprehensive medical services from a range of other specialties.
“The
implementation of this report will be a challenge - but we agree that it must
be addressed. Unifying and integrating the hospital and wider healthcare
facilities, including those related to primary and social care will benefit the
care for our present and future patients.”
Peter Carter,
chief executive and general secretary of the Royal College of Nursing, said:
“The Future Hospital Commission looks at some of the most pressing challenges
facing the NHS, including rising emergency admissions and how to provide better
care for patients with increasingly complex conditions.
“The
commission rightly focuses on a patient-centred approach to care, and the
smooth and safe transfer of patients from hospitals to the community, he said.
“Nurses play a vital role in delivering community services so are perfectly
placed to work with patients, their carers and other agencies to help keep
people as healthy as possible and out of hospitals.”
Neil Harris
(a don’t stop till you drop
production)
No comments:
Post a Comment