The litany of challenges facing hospitals is by now familiar: rising demand, spending restraint, making the best use of new technologies, and finding ways to adjust the acute sector to a world of chronic illness.
A service that has struggled to make progress on productivity for decades now faces a future in which there will be no alternative but to make steady efficiency improvements, year on year, while at the same time maintaining a level of quality upon which vulnerable people depend.
The task is daunting, but I remain an optimist. I believe we increasingly understand what needs to be done, and that the willpower needed to do it is gradually building. If a single number tells us where we should look first, it is the National Audit Office’s finding that 30 per cent of all non-emergency admissions are avoidable.
I see many people in the NHS who would embrace reconfiguration that allowed them to spend more time working where they could do most good
If we do not make sure our care services work together to address this, this figure will grow steadily as our ageing population sees chronic illness and multiple morbidities account for a rapidly increasing proportion of caseloads. Accepting this status quo is not an option. We must view this change in what hospitals do as an opportunity, not a problem.
We can’t heal a broken leg or a sudden bout of flu before they happen; but we can ensure that people with diabetes or chronic pulmonary disorder are dealt with as soon as their condition begins to worsen, and that they and their families are able to manage their conditions to the best of their abilities.
We need to build more exit points on the path that leads patients to hospital, and we need to reconfigure hospitals themselves to optimise efficiency and quality.
Fifty years ago, Enoch Powell struggled to move patients out from the massive asylums that dotted British cities into flexible, local community care systems which could deal with them as individuals.
He spoke of hospitals as “shells” for the care that goes on inside them, and warned against the danger of forming an attachment to them rather than to the purposes for which they were built. I believe we face a similar challenge today.
Powell suggested that it was from the professions that he feared resistance to change. But I see many people in the NHS who would embrace reconfiguration that allowed them to spend more time working where they could do most good. Perhaps a greater problem is an understandable fear of changes to local hospital arrangements among those who rely on their services.
Politicians of all parties owe it to the public to have an honest dialogue here, rather than trying to exploit confrontations for short-term political gain. This is not to say that reform will always mean closures or consolidation. New technologies like smartphones and telecare are making it easier than ever before for consultants’ expertise to be brought into homes and GP surgeries.
In future, the cost of communication will only fall further and we must be ready to ensure that we take full advantage of the flexibility this brings. The Secretary of State’s decision earlier this year on the reconfiguration of Lewisham hospital was based on a clear assessment of clinical need and a willingness to risk political difficulties. It was a promising precedent, but the time for precedents is passing.
Our mindset needs to be one that accepts the need for on-going reform. For everyone responsible for hospitals – politicians, managers, clinicians and the public – innovation and change should be seen not as an interruption, but as part of the day job.
Rt Hon Stephen Dorrell MP is Chairman of the Health Select Committee. Please note that the views expressed in guest blogs on the Nuffield Trust website are the authors’ own.
To read further reflections from parliamentarians on the recent NHS reforms, download a joint report from the Nuffield Trust and The King’s Fund: The view from Westminster: Parliamentarians on the future of health and social care (June 2013).
Dorrell S (2013) ‘The challenges facing our hospitals – doing what needs to be done’. Nuffield Trust comment, 20 June 2013. https://www.nuffieldtrust.org.uk/news-item/the-challenges-facing-our-hospitals-doing-what-needs-to-be-done