The Future Hospital: A new vision for clinical care

Nuffield Trust June 9th 2014

The need for a new vision of clinical care

• Rising clinical demand

• Changing needs

• Fragmented care

• Out-of-hours care breakdown

• Medical workforce crisis

21st century hospital patients

• Nearly 2/3 are over 65

• Half of those over 60 have a chronic illness

• 1/4 have dementia

• Is past training fit for future patient need ?

The needs of patients in the 21st century

• Collaboration at all levels and across all sectors

• Complex vulnerable patients with multiple and long term needs conditions have most to gain

• Holistic approach to all clinical, care and support needs

• Health, social care, housing, local government

The vision of the future hospital

• Hospital services operating across the health economy

• Seven-day services in hospital

• Seven-day services in the community

• Continuity of care as the norm

• Stable medical teams in all acute and ward settings

• Access to coordinated specialist care for all patients

The vision of the future hospital

•Early senior review across medical specialties

•Intensity of care that meets patients’ needs

•Medical support for all hospital inpatients

•Alternatives to acute admission, supporting transfer

•Care delivered by specialist teams in community settings

•Holistic care for vulnerable patients

Reaction

‘Doctors propose cure for failures on wards’ Welcome to the

hospital of the future

‘Most important statement about the future of British medicine for a generation’

‘…bold and refreshing’

‘the result could be a step change in the quality of care’

….

Realising the vision: future hospital in practice

Lewisham and Greenwich NHS Trust

Front door geriatric assessment in Emergency Department

Multi-disciplinary team including therapists and social workers

Results: reduction in hospital admissions of average 30 patients per month

Nottingham Queen’s Medical Centre

Ambulatory emergency care for all GP referrals to medicine

Consultant-led assessment

Results: 30 – 40% of GP referrals discharged on same day.

Realising the vision: future hospital in practice

Plymouth Hospitals NHS Trust

52 bedded AMU 20,000 patients a year 60-80/24hrs

Ambulatory Care Unit 8 chairs 4 consulting rooms

From 30 to 37% same day discharge over 6 mnths

2/3 seen and discharged in 2 hrs

95% pt satisfaction

40% acute medical referrals Carter A, Clin Med 2014 14 3 250-254

Realising the vision: the Future Hospital Programme

Develop and implement the RCP vision for the future of medical care in hospital and community settings

•Dr Mark Temple – Future Hospital Officer and dedicated staff team

•3 year programme

Realising the vision: the Future Hospital Programme

Partnership Network And 4 Development Sites Translation Demonstration

Promotion of good practice Patient centred, shared decision making Generate discussion and debate Develop models, resources, guides, networks Evaluate service change – QI Partners NHSE pioneers, RCGP, Monitor, TDA, CQC,

Realising the vision: the challenges

• Commissioning integrated care pathways

• Different funding models for health and social care

• Tariff and HRGs

• The consultant contract

• Medical training

• Information and data

Programme Themes

Patient centred care

Quality, standards, & data

Education, training, CPD and support

Workforce planning

Academic Medicine & Research

Organisational development

Development

sites

Double GP training places 2015

3-4% growth consultant workforce

Run through emergency medicine training

Additional 75 ACCS posts

HEE

Broad based training

Acutely ill patients

Fit to practise at graduation

Registration at graduation

Pt involvement

Generic capability framework

HEE

Hard Truths

“ Targets or finance must never again be allowed to come before quality of care”

Almost half acute hospitals in deficit end 2013

3% increase nurse staff levels Sept-Nov 2013

NHSE spec services overspent by £360m 3.8% in first 9 mnths

http://www.nuffieldtrust.org.uk/blog/are-wheels-finally-coming-nhs-finances

15% cut in real terms since 2010