Since the money stopped flowing freely into the NHS, there has been a relentless focus on the hospital. Recent concerns about quality are matched by continuing concern about money.
They come together in the increasing professional and managerial clamour for reconfiguration as the solution to quality and financial issues, targeting smaller hospitals in the way stranded explorers might look hungrily at their weakest comrade.
The recent Royal College of Physicians report takes a different slant. It concentrates on how hospitals should work, not on how many there should be.
The report sums up the current position as ‘All too often our most vulnerable patients – those who are old, who are frail or who have dementia – are failed by a system ill-equipped and seemingly unwilling to meet their needs’.
Their answer is to change the way hospitals work, and importantly to reach out more into the community
As if that wasn’t bad enough, it went on to warn of a looming crisis in the medical workforce, with consultants and medical registrars under increasing pressure, and difficulties recruiting to posts and training schemes that involve general medicine.
Their answer is to change the way hospitals work, and importantly to reach out more into the community. Working closely with GPs, community services and social care much specialised care will be delivered in or close to the patient’s home.
Physicians and specialist medical teams will expect to spend part of their time working in the community, with a particular focus on caring for patients with long-term conditions and preventing crises’, and be assessed on how well they meet the needs of the health economy, not just patients on the ward.
This vision isn’t mutually exclusive to concentrating hospital services, but it has a different feel to it with the hospital, in the shape of the people, coming to you rather than you trekking further to them. It might even mean a reprieve for the smaller hospital, currently being written off maybe before its time, even if it means a different shape.
It might even mean GPs and specialists working so closely together that they join a single organisation – breaking the mould of the nineteenth, let alone the twentieth, century.
Reconfiguration advocates say that more services would be delivered in the community but less attention is paid to how that will be achieved – it is 20 years since we expressed that aim – nor to how primary care might organise itself better to receive them, although our work on the changing shape of primary care points the way to what that might look like.
The link between the changing shape of hospitals and primary care is also something our next ’Euro Summit’ will explore in January. With KPMG, we will be debating the future of hospital services in Europe, drawing on contributions from across the continent. It is always comforting to know that you are not alone.
The pressures are much the same in most European countries, but the solutions can be different. Have you noticed how many small hospitals there are in Germany, and how they seem to offer good quality services?
McKeon A (2013) ‘New century, new hospital’. Nuffield Trust comment, 30 September 2013. https://www.nuffieldtrust.org.uk/news-item/new-century-new-hospital