Hospital Dr News

Reconfiguration: don’t cut specialist providers

Plans to reorganise hospital services must recognise the unique expertise and class-leading outcomes of specialist hospital services, the Federation of Specialist Hospitals has warned.

The body is calling on NHS England to clarify its intentions regarding the reconfiguration of specialised providers in England.

The Federation cautions against a one-size-fits-all approach and emphasises the need for change to be driven by clinical considerations.

NHS England has suggested that it plans to reduce the number of providers of specialised services from 270 to 30 or fewer.

Since April 2013, NHS England is the sole direct commissioner of all specialised services with a related budget of about £13 billion, over 10% of the NHS’s total spend. Specialist hospitals carry out 250,000 procedures and 2.5 million outpatient appointments each year.

The report highlights the high performance of England’s specialist hospitals.

Professor Tim Briggs, chair of the Federation of Specialist Hospitals, said: “The Federation’s report highlights the excellent clinical and patient-reported outcomes achieved by specialist hospitals in both routine and complex services. In an NHS where the experience of the patient comes first, hospitals that deliver the best outcomes for their patients should be at the heart of the service.

“The FSH supports the reorganisation of specialised services, where there is a clear clinical rationale focused on providing high quality care. Reconfiguration of services, should concentrate provision in centres with the best outcomes for the relevant medical specialty, with appropriate sharing of this expertise through networks, rather than seeking to concentrate more services in just a few large hospitals.”

Moorfields Eye Hospital, for example, carries out about 330 drainage tube surgery procedures for intractable glaucoma each year. This involves the placement of a permanent plastic tube to allow fluid to escape from the eye. A 2012 audit found that the procedure had a success rate of 98% at Moorfields, compared to other centres where success rates are around 80%. The occurrence of complications was also significantly reduced to 3.4% at Moorfields, in contrast to 20% at some other centres.

93% of staff at The Christie who responded to the 2013 NHS staff survey reported that they would recommend the hospital to their family and friends. In a 2012 staff survey, 89% of staff at the Royal National Orthopaedic Hospital either agreed or strongly agreed that they would recommend the trust to their family and friends.  This compares favourably with the NHS staff survey national average, where only 63% of NHS staff said they would recommend treatment by their organisation to family and friends.

In December 2013, NHS England published guidance entitled Everyone Counts: Planning for Patients 2014/15 to 2018/19. This guidance included the statement of intent which anticipated the concentration of specialised services in 15 to 30 centres.

Very little information regarding these plans have been made available since the publication of the planning guidance.

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