Posts Tagged ‘Reconfiguration’

No political willpower to tackle NHS challenges

By Mike Broad - 1st April 2014 10:07 am

Half of MPs (48%) fear a free NHS may be unsustainable if challenges facing the service are not tackled.

This is the key finding of a survey by the NHS Confederation - published on the first anniversary of the NHS reforms - which polled a cross-section of 100 MPs for their views.

The survey also reveals that 81% of MPs believe the NHS in their constituency needs to change to meet the needs of patients in the future.

Yet 65% say there is insufficient political will to permit change, and one in four say they would not back changes to their local NHS if their constituents are opposed.

Rob Webster, chief executive of the NHS Confederation, said: “These results reveal there is cross-party consensus about the need to make changes to the NHS and that there are doubts about whether there is the political will to do so.

“This comes on the back of our member survey published last week, that showed significant backing for change from NHS senior leaders, who voiced doubts that change will be achieved in the current environment.

“The resounding message from this survey is clear – we need an open and honest apolitical conversation between the public, patients, politicians and those delivering healthcare across our communities, about the future challenges facing the NHS.”

Dr Ian Wilson, chairman of the BMA’s representative body, said: “The government must not risk the NHS’ core value of being based on need, not ability to pay, purely because they are unwilling to take action and make the changes they admit are desperately needed.

“It is unbelievable that while eight out of 10 politicians agree change is essential, almost seven out of 10 say there is insufficient political will to allow this to happen.

“The reality is that the NHS is under intense pressure from a combination of rising patient demand and declining funding. Politicians must confront these challenges head on in order to ensure we can continue to deliver a high standard of care while remaining free at the point of use.”

MPs’ responses to the survey:

Q1. The NHS needs to change in my constituency to meet the needs of patients in the future

81% of all respondents strongly agree/agree

Breakdown by party:

Conservative – 85 per cent strongly agree/agree

Labour – 73 per cent strongly agree/agree

Lib Democrat – 75 per cent strongly agree/agree

Other – 80 per cent strongly agree/agree.

Q2. There is sufficient political will to permit such changes

35% of all respondents strongly agree/agree

Breakdown by party:

Conservative – 41 per cent strongly agree/agree

Labour – 23 per cent strongly agree/agree

Lib Dem – 51 per cent strongly agree/agree

Other – 40 per cent strongly agree/agree.

Q3. Any such changes are likely to be opposed by my constituents

43% of all respondents strongly agree/agree

Breakdown by party:

Conservative – 43 per cent strongly agree/agree

Labour – 46 per cent strongly agree/agree

Lib Dem – 38 per cent strongly agree/agree

Other – 20 per cent strongly agree/agree.

Q4. If the challenges facing the NHS are not addressed, then it may not remain free at the point of need

48% of all respondents strongly agree/agree

Breakdown by party:

Conservative – 53 per cent strongly agree/agree

Labour – 39 per cent strongly agree/agree

Lib Dem – 50 per cent strongly agree/agree

Other – 60 per cent strongly agree/agree/

Q5. What would persuade you to back changes to your local NHS?

Public support of plans by clinicians – 69 per cent of all respondents strongly agree/agree

Evidence the changes will improve patient care – 93 per cent of all respondents strongly agree/agree

Evidence the changes will save money – 53 per cent of all respondents strongly agree/agree

None of the above if constituents are opposed – 25 per cent of all respondents strongly agree/agree.

NHS must spend billions on reform or disappear

The Guardian - 13th March 2014 1:25 pm

Billions of extra funding will be needed for the NHS to help push through “painful and unprecedented” changes during the next parliament, the outgoing boss of the health service warns.

In a frank interview with the Guardian, Sir David Nicholson said that whoever formed the next government would need to give the NHS extra cash because it could not survive if it had to remain in the straitjacket of austerity-era flat budgets after 2015.

The money would be needed so the NHS can dramatically rationalise hospital services, and concentrate its specialist and GP services – allowing an NHS Nicholson calls “unsustainable” to ditch its outmoded reliance on hospital-based treatment and switch to a new model of community-based care.

Nicholson declined to say how much more cash he believed would be required, but another senior NHS leader privately suggested it could be up to £5bn extra a year for several years.

Read more in The Guardian.

Positive contract negotiations key to NHS survival, BMA says

By Dr Mark Porter, chair of BMA council - 3rd January 2014 6:42 pm

The period between Christmas and the January credit card bill can be one of nervous denial, but we eventually face up to our excesses and pay for them, in the gym or in the bank.

The NHS is in a different situation. The financial outlook is dire, but if there ever was any extravagance in the 25 years I have worked in the health service, I must have been off that day.

No, the NHS is struggling just to keep pace. A growing and ageing population, public health problems like obesity, and constant advances in treatment and technology are all contributing to push NHS costs well above general inflation.

The increases in costs may be inevitable – the Health Select Committee has estimated demand will grow at 4% per year – but the corresponding budget increases are not. In June, the Chancellor gave the NHS in England a rise of just 0.1% above general inflation between 2014-2015 and 2015-2016 – more than most public services but significantly less than the costs facing the health system. The allocations in Scotland, Wales and Northern Ireland are also tight.

The numbers overall are so bad that if the NHS were a country, it would barely have a credit rating at all. The Nuffield Trust has estimated that if the NHS budget continues only to keep pace with general inflation, there will be a shortfall of between £44 billion and £54 billion in England by 2021-2022, unless there are productivity gains.

But even with a 4% productivity gain every year, the funding gap would still grow to as much as £34 billion. It would take savage cuts to even begin to find this much money out of further ‘efficiency’ savings.

And efforts to generate savings to date don’t encourage optimism. We are now part way through the Nicholson challenge – the initial drive to find up to £20 billion recurrent of savings in England over the four years up to 2015. In the first year of the challenge, more than half of the £5.8 billion savings achieved were from reducing tariff payments to providers or cutting staff pay through freezes. The Commons Health Select Committee subsequently warned the government that neither were a ’sustainable form of efficiency gain’.

The National Audit Office said the NHS had made the ‘easiest’ savings first. They were certainly not easy for the doctors and other healthcare staff who were made to bear the brunt. And it was not easy for the patients and staff every time a vacancy is not filled, a ward is closed, or a clinic is cancelled.

However, it is beginning to be more widely recognised that more fundamental change is required. Though, not necessarily, the kind of change most of us would want. A senior NHS leader warned recently at a policy gathering that efficiency savings would not be enough in the years ahead, and that the NHS would have to ‘take out capacity’. That translates as cutting services to patients.

What are the alternatives? There have been some thoughtful and brave efforts to reconfigure services in ways that maintain or improve quality while also increasing efficiency, much of it thought up and led by clinicians. The transformation of stroke services in London is one such brilliant but rare example.

But such strategic approaches require clear and credible leadership to be successful. A major problem, in England at least, in that in a post-Health and Social Care Act world no-one really knows who is in charge. Too often, service change decisions are driven by a mishmash of political and financial imperatives, alienating the local communities that the services are meant to serve.

This is underlined by the government’s recent heavy-handed approach to facilitating service change – with legislation currently passing through Parliament that would give trust special administrators, appointed to run failing trusts, the powers to make changes to neighbouring trusts without consulting patients, clinicians or other providers.

So, what does that mean for our profession? Can we not bring evidence instead of prejudice to the problem?

The negotiations over changes to GP contracts in England for 2014-2015 show that a more strategic approach can deliver for patients and doctors while also improving efficiency. Our negotiators reversed the adverse impact of this year’s contract changes, which brought in unnecessary targets and excessive paperwork, and agreed changes that will enable GPs to deliver more personalised care for vulnerable patients to help them stay out of hospital.

The GP contract negotiations show it is possible to achieve efficiencies and still improve care, rather than having one or the other, or randomly knocking chunks out of the health service budget.

And that’s the point. The solutions are harder to find given the dire financial outlook, but if doctors are given the chance to find them, we can. And we must.

The year ahead will be shaped in many ways by the outcome of contract negotiations for junior doctors across the UK and consultants in England and Northern Ireland currently underway. Within the same cost envelope, we need to find a way of enabling doctors to provide the highest quality care while ensuring fair remuneration, meaningful development opportunities and a healthy work and life balance.

As part of this, we are looking at how best to tackle the ‘calendar lottery’ so that our patients can receive the same high standards of NHS care seven days a week. There are many barriers to overcome, but our recent position paper on seven-day services showed we are willing to take a lead.

One barrier that we need to get rid of as soon as possible is a perception in the media and elsewhere that doctors are part of the problem. We know that a huge proportion of consultants already provide emergency cover out-of-hours and some are regularly present, and as part of our work on negotiating a new consultant contract, we are finding out its full extent.

But the public needs to know this too. You will remember what happened when politicians made inaccurate and demoralising comments blaming GPs for the pressures on emergency care, and we must be alert to these kinds of attacks on our professionalism and integrity, and fight them with facts.

We also have to tackle bureaucracy. All too often, it saps our energy worse than a winter virus. In a survey we published in the summer, two-thirds of doctors said they had wanted to make changes but were held back by red tape or a lack of capacity or support. A similar proportion felt less empowered than they did the previous year.

At a special event we held to draw out the views of juniors and consultants – we have more planned this year – doctors said managers often seemed there mainly to enforce targets and find savings, and that they felt many managers regarded them as irritants in that process. We can no longer afford to have two tribes, because two tribes bring half the benefit to patients.

It is more than just a question of mutual respect. It’s also a willingness to step out of traditional roles and recognise that the financial constraints within which the NHS works are not just an issue for managers, and that good patient outcomes are so much more than a ‘clinical issue’.

It can all sound very aspirational. It is, but look what happens when it is missing. At Mid Staffs, where a managerial obsession with achieving foundation status became more important than anything else, where disengaged and disillusioned clinical staff did not speak out loudly enough, and patient care suffered terribly.

The problems at NHS Lanarkshire were not on the same scale, and an inspection report published earlier this month said clinicians and managers were working hard to do the right thing. But that report contained a very worrying detail – that staff did not always report risks to the delivery of patient care because they believed that management would not take action.

Both cases, although very different, show that giving up can be harmful.

Clearly it is time to put medical professionalism back at the heart of the NHS, and in 2014 we will be starting a major campaign to put modern professional values – like integrity, evidence-based practice, and patient-centeredness – to the fore.

The campaign will aim to empower and support doctors, who want to lead services and shape change. It acknowledges that doctors often feel change is forced upon them, and they want the freedom to make services better for patients.

This will drive our contract negotiations and help doctors take the lead in major issues like seven-day services.

We will also promote the value of the profession, a value that is not always reflected accurately by government or the media. Part of this will be about showing the extraordinary things that doctors do in their ordinary working lives. They happen so often that even we do not always notice them, and we certainly don’t do enough to promote them.

And the campaign will also aim to shape NHS reform so that medical professionalism is liberated. This means that not only will doctors be willing to lead and improve, but the system enables them to do so.

We look to learn from best practice in the health service and outside it, and how those who raise concerns can be supported and protected.

Our work on professionalism is new and urgently needed, but the values that underpin it – integrity, compassion, altruism – can be found all around us, and have always been there in the medical profession. Indeed, while everything else in medicine has changed, they are what connects us with doctors who practised hundreds, even thousands, of years ago, often in harder times than now.

Our aim is to encourage professionalism to flourish, by ensuring the NHS is built around it. In the contracts we negotiate, in the open and engaged way in which we offer to work in partnership to reform services, and most of all in enabling integrity and compassion to be at the heart of what we do, I want this to be a good year for professionalism, and a great one for patient care.

Don’t wait to make NHS changes in 2014

By Partha Kar - 2nd January 2014 2:45 pm

You pause at landmark birthdays, don’t you? Or that’s what the world would have you believe. At 40, stepping into middle age, is it time to slow down? As I sit here and reflect over the past few years, the answer to that becomes obvious.

So what has time taught me? I became a consultant in 2008 and, even in my wildest dreams, I couldn’t have imagined the distance that has been travelled and the experiences gained since then.

My personal learning points? Here we go…

1.) Empathy and evangelism

The NHS has had a major cathartic moment via Mid staffs, Francis report etc and has brought forward a degree of empathy on social media rarely seen before. Empathy is something we learn gradually about but you know what - it is damn tiring to do so 24/7.

Somewhere in the middle, lots have forgotten that healthcare professionals, as anyone else, are human beings…same foibles, same passion, same problems. Does that make them a less empathetic person? No, it  doesn’t.

2.) Power and influence

As one of my good friends recently said, the present currency is not power, but influence. And my observation? Official high ranking posts are now subject to so many rules, regulations and targets that good people end up doing things and getting involved with issues they would never do otherwise. I know so because they are different individuals when they are free from the trappings of such roles. And that’s not for me - change can be brought by influence and that is where it’s at.

Some targets, however, are simply meaningless and continue because of political expediency - and they, unfortunately, are beyond our influence.

3.) Money and practicality

There is a surfeit of folks willing to work differently. At the end of the day, the money has run out. Yes, I know that Clive Peedell will tell you that not having transactional costs would save NHS money, and how not having Trident would help the NHS. But, the reality? That’s beyond the realm of control for folks like us.

They are political issues which at the moment don’t look like getting resolved. So let me put this bluntly, the system has, as things stand, run out of capacity. So an honest dialogue with patients is where it’s at. When there isn’t a service available, it isn’t because the doctors/nurses don’t care or the CCGs are evil. They simply don’t have enough money. Everyone knows it, we just don’t know what to do about it any more.

4.) Leaders and credentials

An explosion of leaders seems to have happened, unfortunately without the supporting credentials. Lots of talk, lots of meetings, lots of lectures, opinions…but dig deep, and these leaders have just been moved around from one failing project to another.

A good speaker and some funky Power Point slides does not make a good leader I am afraid; I recall going to a meeting a few years back on 7-day working when a consultant stood up as a lecturer and passionately put the case for 7-day senior cover. Problem? I was his house officer once upon a time and his contribution to the wards was negligible.

I am very fortunate to be in my position. A consultant working across an acute trust and two community providers, with 80 GP surgeries. It’s been an education, building bridges, appreciating all the pressures, and you know what? There’s no course that will teach you how to develop mutual respect between primary and specialist care.

Making it happen has given us the chance to build influence and I have some big ideas - who needs national documents when you can forge your own way?

Finally, have honest conversations with patients about where things are as regards money but try and work within the system to see what can be done. Example? Patients complained about lack of diabetes input over weekends, so we worked with commissioners, and used existing best practice tariffs and - three months later - we are there.

2014 is about fighting passionately for patients, and working with like minded colleagues to effect big systematic changes but within the present financial margins. Mellow down at 40? No way, it’s time to shift up a gear.

Hospitals must change but for the right reasons

By Francesca Robinson - 17th December 2013 10:56 am

Two senior clinical academics went head-to-head with different views on what the future hospital will look like at Hospital Directions conference.

Professor Tim Evans, set out the Royal College of Physicians’ vision for hospital services structured around the needs of patients.

Professor Evans who is Vice Dean of the Faculty of Intensive Care Medicine and Lead Fellow for the RCP’s Future Hospital Commission project, said hospitals should be based around the principles of   compassionate care, accommodating the Francis report and its recommendations, and should function 24 hours-a-day seven-days-a-week with stable teams who have effective relationships with community care.

There should be a whole system of integrated care merging primary care, community care, mental health and social care with hospitals.

The RCP proposes that instead of having a specialty focus hospitals should provide an acute care hub, a medical division and a clinical coordination centre overseen by a chief of medicine who would bring together the multiple skills that are needed to accommodate the general needs of patients.

Generalists would run the wards and specialists would provide specialist advice but also spend substantial amounts of time in the community delivering specialist procedures. Specialists acting as generalists could also run wards some of the time.

“A seven-day service and compassionate care are important to our population which is suffering increasingly from co morbidity and multiple problems and an integrated whole system care is what’s needed for the future,” said Professor Evans.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, argued that the Future Hospital Commission had come up with the right conclusions but not necessarily for the right reasons.

“I don’t think that the commission really addresses the upstream challenges and the issue of variation in hospitalisation rates for a given community which can vary at least three fold in a relatively small geographical area,” he said.

Part of the argument for seven day working was the interpretation of Dr Foster data which appeared to suggest that people admitted over the weekend were more likely to die than those who were admitted during the week. However the data was collected for an entirely different purpose therefore any conclusion was based on indirect interpretation of the evidence.

Professor Baker said there was significant supporting evidence gathered from stroke units which showed that any variations in mortality could be reversed by better organisation and stronger clinical leadership.

“The bald statistics suggest that people admitted to hospital on Saturdays and Sundays have a 10% higher fatality ratio than those admitted during the week. But when examined from a population level - that is a community served by a given hospital - the actual admission rate falls at the weekend by about 25%. So for a given population the chances of dying in hospital following an emergency admission to hospital based on the Dr Foster data actually drops by 13% over a weekend,” he said.

There was a more powerful case for seven-day working based on the philosophical argument that patients’ needs should be matched with the availability of expert attention regardless of where they were and regardless of where most needs were required.

Professor Baker also criticised the RCP’s proposal that specialists should take their turn managing medical emergencies. He said this would result in relatively deskilled doctors running wards who would then have to over rely on tests, technologies and guidance – this could result in clinicians losing the power to think.

He concluded that reconfiguring services was the way forward for hospitals in the future. “If you’re going to provide the same quality of service and it’s going to be based on consultants seeing patients first and there is less money available to do it, that equation adds up to delivering care in fewer places and I don’t think there is any alternative to that.”

Kaiser P’s change driven by accountability

By Francesca Robinson - 11th December 2013 12:23 pm

The death of a 25-year-old man whose was given the wrong medicine via epidural triggered a drive to transform care and quality across the entire healthcare system of the American healthcare organisation Kaiser Permanente.

“The physician who administered the medicine was so devastated she never practised medicine again and the incident shook the region to its core.

“This kid should not have died and it was our failure that created his death,” Gregory A Adams, Executive Vice President, Group President and Regional President of Northern California, Kaiser Permanente told the Hospital Directions conference.

The incident led to the leadership of the organisation making a commitment that they were going to do whatever was possible to make sure that such an accident would never happen again.

Kaiser Permanente is an integrated managed care consortium, based in California, which serves 9.1m patient members across 8 states, 39 hospitals and employs 17,000 physicians and 49,000 nurses.

Through a system-wide leadership-led process they developed an evidence based approach to administering high risk medication. “Six months in to the new process we had 95% compliance and from 2006 to this day we have not had another death or major injury from a high risk medication. The incident made us realise that the system was willing to change and this was an opportunity to improve,” said Mr Adams.

Concern about soaring costs of healthcare in California where premiums had rocketed by 157% was another pressure for change and for cutting the costs.

“I realised there was great variation in quality and service and decided that we could tackle both the quality and the affordability agenda by doing the right thing for our patients. The message which we led with was that our aim was to provide the right care for the right patient at the right time in the right location with the right outcome,”csaid Mr Adams.

Leadership was aligned and people within the organisation were encouraged to think about how they could improve processes and their jobs. Data was really important for driving large scale, sustainable change and enabled everyone to stay focused on achieving the desired outcomes.

Four goals were identified: to improve the quality of leadership, give patients an exceptional experience, provide care without delay at the right time and ensure the workforce was skilled and motivated.

They also developed a sense of accountability. Mr Adams said one of the ways he did this was to bring various leaders into his office for three day meetings to work through what was working that should be maintained and what wasn’t working that had to be focused on and improved. Then they pulled in experts from around the region to design the best evidence-based practices that would achieve success.  These were cascaded down the line to medical centres and everyone was trained on what needed improving.

Transparency in medical centres was improved with increased monitoring centrally of their performance and data.

“One of the things we were ruthless about was that processes should be the same across the organisation but at the same  time we also created ways that allowed local teams to innovate,” said Mr Adams.

Multi-year goals, scorecards and a system-wide dashboard were created so that they could drill down into all the transformational initiatives and identify when thy turned from red (danger) to blue (improvement).

Alide Chase, Senior Vice President of Medicare Clinical Operations and Population Care, said a good deal of what they had learned about transformational change at Kaiser Permanente had been learned from the NHS.

“Our journey into quality was not one for the faint of heart. Many times we could have said we can’t do this but we had to keep going. Our notion was to keep going so that we could provide high quality healthcare for our population, a good experience for our families and improve the health of not only our patients but also of the communities we serve as well as being affordable,” she said.

Energy key to building transformational change

By Francesca Robinson - 10th December 2013 11:31 am

NHS leaders must build energy in their teams if they are to achieve transformational change, Helen Bevan, a member of the NHS Improving Quality team told the Hospital Directions conference.

Data collected across multiple sectors - education, health, government and the private and voluntary sectors - shows that most large scale change efforts fail to achieve their objectives.

However there is evidence that organisations that really build energy score higher on every criteria for performance whether it is productivity, efficiency or satisfaction.

So the NHS Improving Quality team has focused on energy as an area for improving performance. They have designed an energy index tool to help teams assess their energy for change and identify areas where there is an opportunity to improve. The tool is based five types of energy: social, spiritual, psychological, physical and intellectual.

Ms Bevan said leaders can be focused on change and generate a lot of momentum but the problem is if, for example, people have no social energy, which is about partnership, alignment, collaboration and connection with their teams or organisation, they have no idea how they can contribute to the change process. If staff have no spiritual energy, they have no sense of the higher purpose of why they are trying to achieve change and if they have no psychological energy change will not occur because they will not feel safe and supported.

Leaders can have high intellectual energy, which makes them think rationally and logically, and teams can have high physical energy which motivates action but this is not enough to drive change. Evidence shows that organisations that deliver truly transformational change have a big focus on social and spiritual energy.

“What is useful about the energy framework we have developed is that it means people can have a conversation about energy and language which is very helpful for teamwork, building solidarity and finding out what our shared purpose is,” said Ms Bevan.

The NHS SSPPI (social spiritual psychological physical intellectual) Energy Index on the Change Model website offers over 100 different resources for change focused around different energy can be accessed on the NHS Change Model website.

ARMC’s Seven Day Consultant Present Care - summary

By Mike Broad - 21st November 2013 11:53 am

A new report by the Academy of Medical Royal Colleges sets out how to achieve seven day consultant present care. The following is the executive summary:

It is ethically unjustifiable to provide a lower standard of care to patients at weekends than on weekdays. Medical Royal Colleges have signed up to this principle and have worked hard for the past two years to find ways in which seven day consultant-present care can be achieved for the whole of the NHS and across the UK.

The Academy has led the debate on seven day care and has previously published three standards to support parity of care for hospital inpatients across the whole week.

This report, which has involved over fifty specialty organisations, is designed to be a catalyst, providing organisational and clinical leaders with further support in delivering seven day consultant-present care for patients in hospital.

The report demonstrates the importance of a daily consultant-led review and that moving toward having more consultants with the skills to manage patients across different specialty areas (‘generalists’) will increase the flexibility of the consultant workforce delivering daily reviews at weekends.

Having greater levels of early, weekday engagement and advance discharge planning between patients and their carers, hospital and community-based staff and equipment providers would also help as this would lead to an increase in the ability to make a safe transfer of care from the hospital at the weekend.

The report concludes that to achieve this transformational shift in care is likely to require additional consultant appointments as well as a reorganisation of the existing consultant workforce and increased resourcing for community based services including general practice.

It also notes that optimal value from consultant weekend presence will be achieved if the consultant is leading a multi-disciplinary team of healthcare professionals and the required specialist supporting services are available. Several factors will determine the resources required by trusts to deliver effective seven day consultant-present care. These include the degree to which seven day working is already provided, the case mix within a trust and the skill mix of the trust’s current workforce.

Delivering seven day consultant-present care will have a financial impact, and the likely need for service reconfiguration was noted in the Academy’s first report in December 2012. However, the scope of this follow-up project was the clinical requirements for implementation of the Academy’s three standards, not the economic implications.

Some other key findings are:

- The total amount of consultant time required for inpatient daily reviews at weekends for most specialities will equate to around six hours per day for every 30 inpatients

- The majority of hospital inpatients will benefit from daily consultant review across the whole week, including at weekends, and the review will take less time if a patient is already known to the consultant; rota patterns which optimise continuity of care should be designed to ensure best use of consultant time

- Consultant presence at weekends will enable greater coaching and supervision of doctors in training, and time should be allowed for consultants to deliver training as well as service at weekends. However, this must not discourage the development of decision making skills in junior doctors

- Progression of the patient’s care pathway following weekend consultant review in most specialty areas will require timely seven day access to: Investigations, including (but not limited to) laboratory services, radiology, ultrasound and cross sectional imaging; Interventions, including (but not limited to) emergency surgery, anaesthesia, interventional radiology and therapeutic upper gastrointestinal endoscopy; Support services within hospital, including (but not limited to) physiotherapy, occupational therapy, pharmacy, dietetics, specialist nursing, operating theatres, administrative and clerical support; Patient transport and community support services, particularly social care teams, providers of equipment, community nurses and the ability to liaise directly with primary care.

Read the full report.

Lewisham Hospital: Appeal Court overrules Hunt

BBC Health - 29th October 2013 2:27 pm

The Court of Appeal has ruled Health Secretary Jeremy Hunt did not have power to implement cuts at Lewisham Hospital in south-east London.

During the summer, a High Court judge ruled Mr Hunt acted outside his powers when he decided the emergency and maternity units should be cut back.

The government turned to the Court of Appeal on Monday in an attempt to get the decision overruled.

Mr Hunt had previously claimed the move would improve patient care.

At the High Court in July, Mr Justice Silber said Mr Hunt’s decision was “unlawful” as he lacked power.

Read more at BBC Health.

“Hospital reconfiguration in NHS needed now”

By Francesca Robinson - 9th August 2013 9:50 am

Over the next few years there will be a much greater differentiation between hospitals as we know them with a critical mass of staff concentrating on providing specialist services and those offering community care, predicts Mike Farrar, chief executive of the NHS Confederation.

This is because healthcare services and staff need to be moved away from hospitals in order to release resources for primary, community and social care, he will explain in a talk at Hospital Directions Conference on the future of hospital care.

Centralised specialist services will continue to be important but equally there will be a need for local ‘campuses’ providing a variety of services in the community such as outpatient appointments, testing and screening services, maybe offering respite care and general medical services for people  who need 24/7 care.

Hospital use is forever changing, says Mr Farrar, pointing out, for example, that we no longer have isolation hospitals for segregating patients with communicable diseases or large mental illness asylums housing up to 2000 people.

Audits show that 30-50% of people currently being treated in hospital could be cared for in the community. This means that in the future staff currently working in hospitals will need to be retrained and redeployed into community settings. “We need a hybrid workforce in the community of specialists and generalists. What we don’t need to do is to provide more and more generalists in primary care,” he says.

“We have to find a way to invest in keeping people living independently for longer - not just the frail elderly but also people with chronic disease who, if well managed, can stay well and away from hospital care. The changes that need to be made are much less radical than past transformations of our hospitals but are probably more necessary than ever before,” he adds.

In the next five years Mr Farrar warns that if people do not understand the need to change the way hospitals are configured, waiting times in accident and emergency departments will increase, people will not get the diagnostic tests they need quickly and there could be a need to introduce accommodation charges in the way the prescription charges were introduced many years ago.

“The case for change may well be more compelling if we spelled all this out and let people see what the alternatives actually are. Whether these changes take ten years or only three will depend largely on some of the political horizons and opportunities. But safe care and better outcomes are inexorable issues that must be addressed,” he says.

Mr Farrar says the current pressures on A&E make a very strong case for change. He likens the situation to the M25 problem – you can carry on creating new motorway lanes and throwing money at the issue but eventually you run out of capacity and that doesn’t solve the crisis.

“Constant change can feel very wearing but people should think about it more as being a constant evolution and ensuring that the health service is able to respond quickly to get the best value out of every pound we spend, is using the evidence base we have to care safely care for people and to challenge some of the sacred cows such as ‘this is how we have always done it’.

“We really need to get these ideas under the skin of managers and clinicians. I believe we do have a groundswell of people who now think this is the right thing to do with our hospitals.”

Mr Farrer urges a wide range of healthcare professionals to attend the Hospitals Directions conference. ‘The only way you can change hospital care is by changing the whole system and events like these are important for getting people together to discuss these issues,’ he says.

Here Mike Farrar speak - and a whole host of other thought leaders in and around the NHS - at Hospital Directions, London Excel on 27 and 28 November. Click here to find out more.