Dr Blogs

Improving continuity of care – the boss’s view

Health Secretary Jeremy Hunt gave a “Treating people as patients” speech last week at Guy’s and St Thomas’ Hospital. The take home message was that Hunt wants every hospital in the country to adopt ‘whole stay doctors’.

However, he said quite a lot about how to improve continuity of care that hasn’t been reported. Here’s an extract…

To make a reality of continuity of care, we need to do some other things as well:

We urgently need proper information sharing. Too many hospitals still don’t have a proper PAS system allowing key patient data to be accessed electronically anywhere in the hospital. Our Tech Fund is giving hospitals access to £500m of my Department’s capital funding to progress this, and we need to put the IT problems of the past behind us and get on with this as quickly as possible;

As the RCP says, we must look at whether medical specialties have become over-specialised, not giving as much emphasis as necessary to a broader range of skills. Specialisation has enormous benefits, but it should never be at the expense of personalised care;

As the RCS says, we must look at rigid shift patterns imposed in part as a response to the European Working Time Directive. Good teamwork involves getting to know colleagues who then work more productively in an environment where everyone feels more valued. Of course no one wants to go back to the bad old days of exhausted junior doctors working round the clock. But we should look at whether more flexibility over shifts could improve both training and continuity of care for patients. I look forward to the results from the EWTD Taskforce chaired by the President of the RCS when it concludes in the spring and the Health Education England “Better Training, Better Care” work programme;

We urgently need to progress greater provision of 7-day services in the NHS. Some of the biggest problems occur when the integrated teams available Monday to Friday disappear over the weekends and continuity of care is lost. I strongly welcome Professor Sir Bruce Keogh’s inspired leadership on this agenda and the work of the Academy of Medical Royal Colleges;

We also need proper plans to reduce the number of ward transfers during a single hospital stay. According to the RCP, every change of ward lengthens the average stay in hospital by a day for elderly patients. Of course, for some diagnostic procedures or operations, the patient will need to come to where the kit is – but the basic principle should be care being organised around where the patient is, not patients organised around where the care is. As part of this we need to be better at sending patients to the right ward first time;

We also need to make within-hospital referrals easier and end the referral ping-pong that is such a nightmare for patients with complex needs – as well as being expensive for the NHS. Commissioners should think about creative approaches to making in-hospital referrals easier – such as CCGs and providers agreeing categories of referrals that are automatically approved, or having a clinician on-call to make more complex decisions within 24 hours. Other countries have clinical staff on hand either in the hospital or remotely who are able to authorise further referrals and treatment on behalf of the purchaser;

Services must also adapt to ensure patients can always be discharged safely, like here at Guy’s and St Thomas’s where the pharmacy operates 7 days a week so the right medicines are almost always available when the patient is ready to go; and

We also need to make sure that the right financial incentives are in place for organisations to join up care inside the hospital. I will be asking NHS England and Monitor to consider this as they further develop their new approach to pricing and tariffs.

So, whole stay doctors. Whole person care. Named consultants liaising with named GPs in a way that transcends the walls of a hospital. With names above beds inside hospitals as the starting point.

Our most recent information suggests that around 39% of trusts in England have names above the bed. Or beside the bed, like here at Guy’s and St Thomas’s where you are doing excellent work on implementing this concept.

I am also delighted that the Care Quality Commission has decided to make this one of the indicators that informs the Chief Inspector’s assessment of how well a trust cares for its patients.

So I hope names above beds and whole stay doctors become not just best practice, but universal practice. Universal practice not because of ministerial fiat, but as part of a genuine culture change in which the holistic needs of patients are put at the centre of all the care they receive.

The vision that I have set out today on whole stay doctors is supported by the CQC, NHS England, the Royal College of Physicians, the Royal College of Surgeons and many other professional bodies.

But professional support is not enough, welcome though it is. Because this is a change in culture that has to be adopted enthusiastically – not imposed unwillingly.

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