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Radical changes needed to the way hospitals work

Call for end to patients being shunted around hospital and for care to extend into the community

Ingrid Torjesen

Thursday, 12 September 2013

The way that hospitals work and provide care to patients needs to change so that it is more responsive to the needs of patients, according to a new report from the Future Hospital Commission.

The report ‘Future Hospital: Caring for medical patients’ recommends that care should come to the acutely ill patient, rather than the patient being moved around the hospital. It says that there needs to be a radical restructuring of the wards where acutely ill patients are treated, and a new organisational and management structure whose responsibilities for acutely ill medical patients will stretch out from the hospital into the wider community, developing the idea of a local healthcare system.

The independent Future Hospital Commission was established by the Royal College of Physicians in March 2012 to find solutions to the current challenges facing the NHS – a rising tide of acute admissions, the increasing number of patients who are frail, old, or who have dementia, patients with increasingly complex illnesses, systemic failures of care, poor patient experience, and a medical workforce crisis.

Its latest report contains 50 recommendations aimed at providing a new focus on patient experience, principles of patient care, communication, information and responsibility.

The report says that care should come to the patient, and the patient should not be moved unless it is absolutely necessary for their care and that the patient experience should be seen as important as their clinical outcome. Patients should be fully involved in decisions about their care, with an emphasis on supporting self-care, autonomy and health promotion, it adds. Who is responsible for each patient’s care on any given day, seven days a week, should be clear to the patient, their relatives and carers, and this team should be led by a named consultant working with a nurse ward manager.

A key change required is that patients should no longer be ‘discharged’, the report says, with planning for their future care needs and transfer to intermediate, community, primary, or social care, within a healthcare system, or their return home, beginning on admission. Patients should be assessed and diagnosed by a senior doctor on admission, and acutely ill patients should have access to the same medical care at weekends as on weekdays.

These changes will require new roles and responsibilities for hospital doctors caring for acutely ill patients, the report says. A new post of Chief of Medicine should be created with ultimate responsibility for all adult patients with a medical illness, and there should be a new role of Chief Resident responsible for liaising with junior doctors and helping to plan service design and delivery, including rotas, duties and workload. In addition, more ‘generalists’, skilled in the diagnosis and management of acutely ill emergency patients or those with complex medical needs already in hospital, will be needed to better manage these patients across the hospital and in the community.

Sir Michael Rawlins, chair of the Future Hospital Commission, said: “This report has major implications for the clinical practice of physicians, the training of future generations of physicians, for research and – most importantly of all – for patients. Its implementation will be a challenge for us all – but implement it we must. Our present and future patients will expect – indeed demand – no less.”

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