Patients could in future be treated at home by hospital doctors under plans for a revolution in the way healthcare is delivered which are being published today.
Hospitals will lose much of their central role in the NHS, with more care and treatment being provided in homes and care homes, under radical proposals drawn up by a landmark inquiry instigated by hospital doctors themselves, which has been broadly welcomed by the government.
If implemented, the report of the Future Hospital Commission (FHC) would lead to a major shift towards caring for the sickest patients at home for longer and out of hospital, unless absolutely necessary, by having health professionals come to them instead of them having to attend regular appointments.
The commission, a panel of medical experts, warned that hospitals will not survive unless they dramatically overhaul how they handle the growing number of medical patients, whose more serious illnesses draw heavily on NHS services.
“Our hospitals are struggling to cope with the challenge of an ageing population and increasing hospital admissions. 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,” says the report, which was commissioned by the Royal College of Physicians (RCP), which represents 28,000 hospital doctors.
The report says hospital doctors should increasingly work as part of multi-disciplinary teams of health- and social-care professionals, such as GPs, district nurses and mental-health staff, to help patients stay at home as much as possible, minimise their stay in hospital and receive “seamless”, integrated care wherever they are.
It also recommends two big changes which are either already underway – the NHS’s move towards operating a much fuller range of services on Saturdays and Sundays – or have been demanded by health secretary, Jeremy Hunt, such as a named doctor being in charge of every older patient’s overall care.
Hunt welcomed the plans saying: “[FHC’s] focus on patient experience and a ‘buck stops here’ approach for senior clinicians is bold and refreshing.”
However, serious questions were raised about how the FHC’s ideas could be implemented in the light of comments by Sir Michael Rawlins, a professor and the inquiry chairman, and the RCP president, Sir Richard Thompson, that the plans were drawn up on the assumption that the NHS would receive no real increases in its funding in the near future.
The British Medical Association (BMA), the doctors’ union, said the plan would need “a commitment of resources if it is to work”.
Mark Porter, leader of the BMA, which opposes NHS England’s determination that patients be able to access the same range and quality of services at weekends as on weekdays, added that “with many parts of the current healthcare system at capacity, and some areas like emergency medicine nearing crisis point, how we provide round-the-clock care needs to be carefully detailed and costed.”
He added: “A move to routine seven-day services, for example, would require significantly more investment in staffing and resources, requiring not just more doctors but also specialist nurses, diagnostic services and additional support staff.”
Thompson and Professor Tim Evans, an intensive care specialist who led much of the commission’s work, denied that hospitals would have to close or shrink if more healthcare was delivered elsewhere.
However, that view was contradicted by the Royal College of Surgeons president, Professor Norman Williams. “Delivering the commission’s recommendations will require the reshaping of hospital services and a move towards greater centralisation,” he said, mentioning the “undeniable clinical case” for fewer, larger, centres of expertise.
But Candace Imison, acting director of policy at the King’s Fund thinktank, said the report could help hospitals avoid losing key units because it “challenges the notion that the only solutions to the problems faced by many hospitals are merger or closure, and provides ideas and opportunities to sustain more services locally”.
Thompson warned hospitals against reducing their total stock of beds any further because pressure on them was great and unlikely to diminish.
Many hospitals often have trouble finding a bed immediately for a patient who enters through A&E and needs to be admitted, because they have no spare capacity. But improving the transfer of patients to their homes, care homes or other facilities should ease that pressure, he added.
The College of Emergency Medicine, which represents A&E staff, said the proposals should help relieve the growing pressure on A&E which has forced Hunt to find £500m to help improve services.
Michelle Mitchell, Age UK’s charity director general, said: “It is vital that the NHS gets better at caring for older people, removing the barriers many older people face in accessing treatment and ending the all too common experience that they leave hospital in worse health than when they arrived.”
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