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All the key reaction to Future Hospital report

Sir Richard Thompson, president of the Royal College of Physicians

“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.

“I am grateful to Sir Michael and the Commission for these radical recommendations, and I can guarantee that the report will not sit on a shelf at the RCP, we will be taking the recommendations forward in our work and looking for opportunities to pilot the recommendations in Trusts and elsewhere.  Our patients deserve it.’

Prof Paul Knight, president of the British Geriatrics Society

“The Future Hospital Commission report recognises that older, frail and more complex patients with multiple long term conditions are the main patient group cared for in modern general hospitals.  It is critical that we meet the needs of these vulnerable individuals.  The current health care workforce needs more training in geriatric medicine and hospitals must be age attuned in terms of their physical environments and the skills and cultural attitudes of all staff working within them.  Doctors, nurses and allied health professionals need the right skills and values to provide compassionate and effective care for older patients.

“The evidence shows that when frail older people are admitted to hospital, they are 25% more likely to be alive and living independently at home when they are looked after in a specialist unit for older people.  However, geriatric medicine departments are already stretched as the beneficial impact of geriatricians’ specialist medical skills in hospital and community healthcare are recognised. We support the move towards a seven day a week service but more geriatricians, with their associated teams of qualified nurses, therapists and social workers, are needed to ensure a high standard of specialist care for older, complex patients.”

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Dr Chris Roseveare, SAM president

“The rising numbers of patients being admitted to hospitals with increasingly complex problems has placed emergency departments and acute medical units under huge pressure over recent years. This document recognises that the solutions to this will require some radical changes to the ways in which we deliver healthcare in the future. Acute Medical Units are an integral part of the solution but we must also ensure that high quality, co-ordinated care is provided for patients throughout their hospital stay and following discharge from hospital.

“The report emphasises the need for better continuity of care for patients in hospital; this is particularly important for those with complex needs and those who problems do not fit into a specific specialist category. Almost all acute physicians already have the skills and training necessary to provide ongoing care for this group of patients, and a recent survey conducted by SAM indicated that the majority would be happy to deliver this if provided with appropriate staffing and support.

“Acute physicians, being dually trained in general internal medicine, are ideally placed to provide ongoing, continuous care for many patient groups; however some organisations are already struggling to recruit sufficient numbers of trained consultants to provide a seven day service on the AMU, and an extension of their role will further increase this challenge. The report recognises the importance of increasing the numbers of trained ‘general’ physicians. Over the next few years, several hundred of our acute medicine trainees will become consultants with the skills to take on these roles; it is vital to ensure that we support and develop career pathways for acute physicians to ensure that this remains a popular and sustainable career choice for consultants of the future

“Sir Michael Rawlins and the Future Hospital Commission have produced a document which, if implemented across the UK could deliver substantial improvements to patient care in hospitals; turning this into reality will require clinicians to work closely with their managers, patients groups and commissioners over the coming months and years so we can ensure that the ‘hospital of the future’ becomes the ‘hospital of the present’.”

Dr Neil Dewhurst, president of the Royal College of Physicians of Edinburgh

“Earlier this year the RCPE called for a major change in culture within the NHS following the publication of the Francis Report into the events in Mid Staffordshire and our belief that the NHS had lost its focus . We are encouraged that the Future Hospital Commission, in publishing its report today, has echoed these sentiments, is seeking to place patients at the centre of care and to place greater value on compassion and patient experience.

“While focussing primarily on the NHS in England, the report makes a number of substantive recommendations which have much relevance on a UK-wide basis. Central to this is the need to improve the level of care provided to patients in hospitals by improving the way in which medical services are co-ordinated and delivered across the hospital and, where feasible, extended into community settings.

“The report is to be welcomed, in particular, for its aim to reduce unnecessary ward moves for patients and complements on-going work between the RCPE and the Scottish Government to address this problem in Scotland. In recent months much political attention has focussed on pressures on A&E Departments throughout the UK .

“However, the report emphasises the “hidden” high level of urgent and unscheduled care which is provided in Acute Medical Admission Units and in Intensive Care. There is a need to co-ordinate this more effectively, alongside both A&E and more routine medical care, through a single Division of Medicine. Tackling the problems experienced in A&E in isolation may offer a tempting quick political fix, but will not address the wider underlying issues involved in providing unscheduled care.

“We also strongly support the recommendations that there is a named consultant responsible for every patient; that services should be re-designed to ensure a consultant presence, with available diagnostic and support  services, 7 days a week; and that there should be a mandatory requirement for all medical specialists to be trained in the provision of general internal medical care.

“With more patient and professional organisations adding their voice, the case for cultural change within the NHS has never been greater, but will require political commitment, throughout the UK, to resource the service that patients need and doctors wish to deliver.”

Dr Cliff Mann, president of the College of Emergency Medicine

“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.”

Nuffield Trust chief executive Andy McKeon

“Caring for medical patients is a thoughtful contribution to the debate over how to deliver greater continuity of care to acutely ill patients in the NHS. Whilst its main focus is on fitting hospital care more closely around patients, the report also recognises that to make its compelling vision a reality,  reform is required throughout the wider health and social care system. Our own recent work proposing new models of primary care fits within that line of thinking.

“The challenge now for policy makers, managers and clinicians is to plot a practical course, drawing on this report and others, for reaching that destination. Many of the changes needed depend on the shape of the medical workforce, changes in working practices, developments in healthcare IT and alterations to NHS funding arrangements. This will all take time to effect, but that is precisely the reason for greater urgency.”

Professor Norman Williams, President of the Royal College of Surgeons

“At the heart of this report is the concept of healthcare professionals taking collective responsibility for patient care, working cohesively to deliver a true seven day service. As the Commission states, every effort should be made to improve early diagnosis and treatment – something that is particularly important for many conditions requiring surgery.

“Delivering the Commissions’ recommendations will require the reshaping of hospital services and a move towards greater centralisation. There is an undeniable clinical case for change as concentrating specialist services into fewer, larger centres of excellence can improve patient outcomes and make services more sustainable. However we must ensure that services are designed to enable patients in less populated areas to receive the right continuity of care. The challenges ahead will mean clinicians, managers and politicians working collaboratively to support the changes which will deliver the benefits we all want to see.”

Dr Mark Porter, chair of BMA Council

“Doctors have long recognised the importance of putting patients at the centre of the health service and support the principles driving these recommendations. Strengthening the doctor patient relationship is something we fully support but the proposals will need joined up thinking, planning and a commitment of resources if it is to work.

“Since its inception the NHS has had to respond to changing patient needs and with the current system facing pressures from an ageing population and a significant number of people with complex long-term conditions, changes to the way services are delivered are inevitable. The report’s proposals about new structures and roles are interesting and worth exploring.

“There should be no down time in the provision of care and patients should rightly expect to receive the best care possible whatever day of the week they fall ill or need care.

“However, 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.

“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. At a time when the NHS is having to make significant efficiency savings, it’s unclear how this would be funded.

“We support the report’s calls for greater continuity of care which will help to improve clinical outcomes. We too have called for greater integration between primary and secondary care, and community and social care.

“However the government’s market-based healthcare policies can make this more difficult to achieve in practice.

“Crucially, doctors need to have the time and support to deliver high-quality patient care. Too often in recent years we have seen short-term thinking resulting in cuts to the time doctors can spend innovating and improving patient care.

“The principles behind the report are the right ones for directing future healthcare provision. Patients should always be treated with respect and dignity and their clinical outcomes and experience should be at the heart of the NHS.”

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