Partha Kar

Lots of recommendations but too few solutions

Waited expectantly for this one. After all it’s the Royal College of Physicians. Have ignored all the snide remarks about the college being “elitist”, and “out of touch”.

I hoped for ground breaking recommendations on the Future Hospital. So it came to pass. Without fail, the PR machine whirred into gear – Twitter was abuzz about the amazing report, the groundbreaking findings.

So what’s my verdict? Well, unless the last few years didn’t happen or all my conversations with colleagues are a dream, then I have struggled to find anything which any physician wouldn’t ask for. The recommendations all make absolute sense – clinical judgements based on patient needs, etc.

The problem? Absolute tiddlywinks about how to implement them.

Let me give you an example: “Once admitted to hospital, patients will not move beds unless their clinical needs demand it”. Brilliant, well said, and there is no physician who will disagree with that.

But how the bloody hell do you do that? In the middle of the night, when the front door is heaving, when there is pressure to transfer a patient out of A&E to ensure the 4-hour target is not missed, the 88-year-old lady will get moved from the base ward to an outlier ward. This is not because there is any clinical need but because a bed is needed.

You could argue the patient in the queue has a clinical need, but what about the 88-year-old lady? Nope – none whatsoever. She’s still moved irrespective of whether the clinical team have disagreed.

So what’s the suggestion on how to do that and avoid the 88-year-old being moved to an outlier? Err, the college stays silent on that.

Want another one? OK. “There will be a consultant presence on wards over 7 days”. Again, superb. Patients need it – and indeed some specialities who are blessed with staff numbers do indeed do this. So how do you make that uniform? Well, it’s possible but the present conundrum is this. To achieve 7-day cover, you need to “time shift” the work of existing personnel, which simply put means that those who do the weekend will also need a bit of time off in the week (shock and horror, consultants actually are human beings and have families too).

This means that unless someone else is backfilling their job, their outpatient work has to be cancelled. Do please someone let me know which pituitary clinic or adolescent diabetes clinic I should cancel and let the patients know? What all these front door policy makers sometimes forget is that for the patient who has a pituitary tumour cancelling their clinic appointment is no less traumatic than the patient at the front door of the hospital awaiting a senior opinion.

And finally, the best one,  “Generalist and specialist care in hospitals”. Come on guys, tell us who the generalists are!

Why in a DGH can’t you say ALL need to have a generalist role? Why should a cardiologist or a gastroenterologist be separate and “special”.

Should I be the same and walk away and be a “specialist”, or are the patients admitted with DKA not as important as those with chest pain or a bleed? Why can’t I provide a 7 day service for all diabetes patients only too?

This is where the document underwhelms and fails to deliver. It fails to grasp the nettle and lay out what the vision is.

Let’s stop pretending we’re all a large London teaching hospital. It’s simple: either its “all in” on general medicine or it’s “all out” i.e. we all run their own speciality on-calls and leave the acute physicians and geriatricians to deal with the rest.

You can’t have a half way house, as the present situation is.

So the overall view of the Future Hospital report? Ambitious, well meaning, but without any clues as to how to deliver the recommendations. A lot of smoke but sadly, little fire.

A hospital can do all it want, but until the budgets between health and social care are fused, until the targets are fused, then a utopian hospital will always be in the future.

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