Hospital Dr News

“Let go of outdated hospital-or-bust care”

Political and healthcare leaders must persuade the public to let go of the outdated “hospital-or-bust” model of care in 2012, the NHS Confederation chief executive has claimed.

In setting out the big challenges for the year ahead, Mike Farrar warns of a potential loss of confidence in the NHS unless political and healthcare leaders make a compelling case to the public for changes to the delivery of services.

He believes that at least one in four patients would be better off being cared for out of hospital and resources must be shifted into community-based services, early intervention and self care.

Farrar calls on political and NHS leaders need to be “honest about the issues, bold about the solutions and decisive in taking action”.

They must offer the public a compelling vision of how services can be better after the changes. They must avoid the traps of focussing exclusively on the closure of some hospital services and failing to explain how the public would benefit overall, he says.

The NHS is already trying to make £20 billon worth of efficiencies by 2015 in order to cope with a flat budget and rising demand. But Farrar says the economic backdrop suggests that the age of austerity will now go on even longer, making the task more urgent.

He said: “We have had a lot of talk about changing services but 2012 must be the year we convert talk into action. It feels like the focus is on everything but the thing that would make most difference.

“Hospitals play a vital role, but we do rely on them for some services that could be provided elsewhere. We should be concentrating on reducing hospital stays where this is right for patients, shifting resources into community services, raising standards of general practice, and promoting early intervention and self-care. There is a value-for-money argument for doing this, but it not just about money and the public need to be told that. This is about building an NHS for the future.”

He identifies four factors that would help bring about change: strong political leadership – politicians have failed to support the NHS even when the case for change has been clear; strong clinical leadership – the voice of clinicians will be more powerful than ever under the new system but they must not be set up to fail through lack of support; changing how health services are paid for -perverse incentives often mean it may not make financial sense to provide care out of hospital even though this may be best for patients; and, listening to the public  – NHS must always listen and be prepared to change course when it is getting something wrong.

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One Response to ““Let go of outdated hospital-or-bust care””

  1. Malcolm Morrison says:

    What are all these services that SHOULD be provided ‘out of hospital’ and ‘in the community? Apart from some of the ‘inappropriate’ atteneders in A&E (that used to be called ‘Casualty’ – for the ‘casual’ attender!), how many patients attend OPD that should not be there, or get operations that should NOT be done?

    Of course, consultants can do ‘clinics’ outside hospitals; but they will usually see fewer patients, they will spend more time travelling (unproductive) and they will not have the back-up of other departments (so the patient would still need to attende hospital). I cannot see an Xray facility (and certainly not an MRI scanner) in every GP surgery or even ‘community clinic’. Are we to go back to operating on the kitchen table?! Has anybody actually worked out the ‘cost-effectiveness’ of some of the proposed ‘community activities’?

    I have yet to see any reasonable audit of any ‘new’ practice of work that is being done ‘in the community’ as opposed to hospital. Let us se the ‘evidence’.

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