Hospital Dr News

STPs must prove NHS hospital bed closures will not compromise patient care

Hospital bed closures arising from proposed major service reconfigurations will in future only be supported where a new test is met that ensures patients will continue to receive high quality care, NHS England has announced.

As part of their Sustainability and Transformation Plans, some health regions are proposing a reduction in hospital beds with more care being delivered in community settings.

But, from April 1, local NHS organisations will have to show that significant hospital bed closures meet one of three new conditions before NHS England will approve them to go ahead.

These conditions include demonstration that sufficient alternative provision, such as increased GP or community services, is being put in place alongside or ahead of bed closures, and that the new workforce will be there to deliver it.

They will have to show that specific new treatments or therapies, such as new anti-coagulation drugs used to treat strokes, will reduce specific categories of admissions.

Furthermore, where a hospital has been using beds less efficiently than the national average, that it has a credible plan to improve performance without affecting patient care.

NHS England Chief Executive Simon Stevens said: “Hospitals are facing contradictory pressures. On the one hand, there’s a huge opportunity to take advantage of new medicines and treatments that increasingly mean you can be looked after without ever needing hospitalisation. So of course there shouldn’t be a reflex reaction opposing each and every change in local hospital services.

“But on the other hand, more older patients inevitably means more emergency admissions, and the pressures on A&E are being compounded by the sharp rise in patients stuck in beds awaiting home care and care home places. So there can no longer be an automatic assumption that it’s OK to slash many thousands of extra hospital beds – unless and until there really are better alternatives in place for patients.

“That’s why before major service changes are given the green light, they’ll now need to prove there are still going to be sufficient hospital beds to provide safe, modern and efficient care locally.”

The new conditions are added to the four existing tests for reconfiguration put in place in 2010. Under those rules, closures can only go ahead with support from GP commissioners, strengthened public and patient engagement, clear clinical evidence and provided that they are consistent with patient choice.

Dr Mark Porter, BMA council chair, said: “While the principle of this move sounds sensible, it is astounding that NHS leaders are still talking about cutting the numbers of beds even though we know that patients are being already unfairly let down by a huge lack of beds in our hospitals.

“Improving patient care must be the number one priority for any service changes and the decisions around providing services should be based on clinical needs. At the moment this isn’t happening and there is a real risk that the sustainability and transformation plans are instead being used as a cover for delivering cuts, starving services of resource and patients of vital care.

“In the short term we need to see bed plans that are workable and focused on the quality of care and patient experiences, rather than financial targets. But in the long term we need politicians to take their heads of out the sand and provide a sustainable solution to the funding and capacity challenges that are overwhelming a health service at breaking point.”

RCP president Professor Jane Dacre added: “Today’s announcement by NHS England is a step in the right direction and recognises that certain conditions must be met before significant bed closures can take place. However, the RCP would urge STPs to reduce the potential impact on patient care and have extra capacity in place before any bed closures occur.

“It further remains crucial that STPs involve their clinical workforce in the development and implementation of the plans; front line workers are best placed to advice on the potential impact of bed closures and other STP measures.”

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