The Future Hospital Commission sets out a radical new model of care designed to encourage collective responsibility for the care of patients across professions and healthcare teams. It recommends new ways of working across the hospital and between hospital and the community, supported by financial and management arrangements that give greater priority to caring for patients with urgent medical needs. This will mean aligning financial streams and incentives, both externally and internally, to ensure that acute services are appropriately supported.
Care should come to patients and be coordinated around their medical and support needs. However, it is not unusual for patients – particularly older people – to move beds several times during a single hospital stay. This results in poor care, poor patient experience and increases length of stay. In the future hospital, moves between beds and wards will be minimised and only happen when this is necessary for clinical care.
Delivery of specialist medical care – such as cardiology and neurology services – will not be limited to patients in specialist wards or to those who present at hospital. Specialist medical teams will work across the whole hospital and out into the community across 7 days.
A new model of care
1.) Medical Division – it will be responsible for all medical services across the hospital – from the emergency department and acute and intensive care beds, through to general and specialist wards. Medical teams across the Medical Division will work together to meet the needs of patients, including patients with complex conditions and multiple comorbidities. The Medical Division will work closely with partners in primary, community and social care services to deliver specialist medical services across the health economy.
The Medical Division will be led by the chief of medicine, a senior doctor responsible for making sure working practices facilitate collaborative, patient-centred working and that teams work together towards common goals and in the best interests of patients.
2.) Acute Care Hub – it will bring together the clinical areas of the Medical Division that focus on the initial assessment and stabilisation of acutely ill medical patients. These include the acute medical unit, the ambulatory care centre, short-stay beds, intensive care unit and, depending on local circumstances, the emergency department. The Acute Care Hub will focus on patients likely to stay in hospital for less than 48 hours, and patients in need of enhanced, high dependency or intensive care.
An acute care coordinator will provide operational oversight to the Acute Care Hub, supported by a Clinical Coordination Centre.
3.) Clinical Coordination Centre – it will be the operational command centre for the hospital site and Medical Division, including medical teams working into the community. It will provide healthcare staff with the information they need to care for patients effectively. It will hold detailed, real-time information on patients’ care needs and clinical status, and coordinate staff and services so that they can be met. In the longer-term, this would evolve to include information from primary and community care, mental health and social care. This information would be held in a single electronic patient record, developed to common standards.
Seven-day care, delivered where patients need it
Once admitted to hospital, patients will not move beds unless their clinical needs demand it. Patients should receive a single initial assessment and ongoing care by a single team. In order to achieve this, care will be organised so that patients are reviewed by a senior doctor as soon as possible after arriving at hospital. Specialist medical teams will work together with emergency and acute medicine consultants to diagnose patients swiftly, allow them to leave hospital if they do not need to be admitted, and plan the most appropriate care pathway if they do. Patients whose needs would best be met on a specialist ward will be identified swiftly so that they can be ‘fast-tracked’ – in some cases directly from the community.
When a patient is cared for by a new team or moved to a new setting, there will be rigorous arrangements for transferring their care (through ‘handover’). This process will be prioritised by staff and supported by information captured in an electronic patient record that contains high-quality information about patients’ clinical and care needs.
Specialist medical care will not be confined to inside the hospital walls. Medical teams will work closely with GPs and those working in social care to make sure that patients have swift access to specialist care when they need it, wherever they need it.
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 7-day basis. The level of care available in hospitals must reflect a patient’s severity of illness.
Health and social care services in the community will be organised and integrated to enable patients to move out of hospital on the day they no longer require an acute hospital bed. Patients can be empowered to prevent and recover from ill health through effective communication, shared decision-making and self-management. Clinicians and patients will work together to select tests, treatments or management plans based on clinical evidence and the patient’s informed preferences.
Patients should only be admitted to hospital if their clinical needs require it.
There will always be a named consultant responsible for the standard of care delivered to each patient.
There will be mechanisms for measuring patients’ experience of care. This information will be used by hospitals, clinical teams and clinicians to reflect on their practice and drive improvement. A Citzenship Charter that puts the patient at the centre of everything the hospital does should be developed with patients, staff and managers.
Education, training and deployment of doctors
A cadre of doctors with the knowledge and expertise necessary to diagnose, manage and coordinate continuing care for the increasing number of patients with multiple and complex conditions is needed.
Across the overall physician workforce there will be the skills mix to deliver appropriate specialistion, intensity, and coordination of care.
In order to achieve the mix of skills that delivers for patients, a greater proportion of doctors will be trained and deployed to deliver expert (general) internal medicine care. The importance of acute and (general) internal medicine must be emphasised from undergraduate training onwards, participation in (general) internal medicine training will be mandatory for those training in all medical specialties, and a more structured training programme for (general) internal medicine will be developed.
The contribution of medical registrars will be valued and supported by increased participation in acute services and ward-level care across all medical trainees and consultants, and enhanced consultant presence across 7 days.
Read the report.