Medical college report calls for seven-days-a-week hospital care
Hospitals must be reorganised so patients do not have to move beds or wards unless medically necessary, a new report says.
Care must also be provided seven days a week, with full access to scans and lab testing even at weekends.
The study, from a commission set up by the Royal College of Physicians (RCP), makes 50 recommendations on the future of NHS hospital care.
It says a rise in admissions and more older patients with complex needs means “hospitals are struggling to cope”, while units are not equipped to provide excellent care on weekends.
“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,” the report said.
It is not unusual for patients to move beds several times during a single hospital stay which “results in poor care, poor patient experience and increases length of stay”.
The study said that, in the future, moves between beds and wards will be minimised. “Once admitted to hospital, patients will not move beds unless their clinical needs demand it.”
And the authors call for a shift to seven-day working, with consultants having a presence on wards and the full range of tests available every day of the week.
Several studies have shown that patients admitted to NHS hospitals at weekends and on bank holidays have higher death rates and poorer outcomes.
The report said: “Acutely ill medical patients in hospital should have the same access to medical care on the weekend as on a week day.
“Services should be organised so that clinical staff and diagnostic and support services are readily available on a seven-day basis.
“There will be a consultant presence on wards over seven days, with ward care prioritised in doctors’ job plans.
“Rotas for staff will be designed on a seven-day basis, and co-ordinated so that medical teams work together as a team from one day to the next.”
Under the plans, arrangements for discharging patients from hospital will also operate on a seven-day basis, with closer links with community services and social care.
The report comes from professor Sir Michael Rawlins, chairman of the Future Hospital Commission which was established by the RCP last year.
It acknowledges that “tough decisions lie ahead” including the reorganisation - and possible closure - of existing services.
“Reconfiguration will almost certainly be needed,” it said. “No hospital can provide the range of services and expert staff needed to treat patients across the spectrum of all clinical conditions on a seven-day-a-week basis.”
The study calls for a new model of “hub and spoke” hospital care.
“It is likely that in many areas, large health economies will be served, not by a number of district general or teaching hospitals, but by a smaller number of acute general hospitals hosting emergency departments and trauma services, acute medicine and acute surgery.
“These hospitals will be surrounded by intermediate ‘local general hospitals’ which, while not directly operating their own emergency department and acute admitting services on site, will contribute to step-down inpatient and outpatient care, diagnostic services and increasingly close integration with the community.”
Sir Richard Thompson, president of the Royal College of Physicians, said: “This is a once in a generation opportunity to improve the way that we care for medical patients.
“When I set up the Commission in March 2012, it was intended to review all aspects of the design and delivery of inpatient hospital care, and to make recommendations to provide patients with the safe, high-quality healthcare that they deserve.
“It has done much more than that. The Commission brought together patients and medical and healthcare experts to develop a vision of the future hospital, a hospital which is no longer bound by its walls, but reaches out into the community to care for medical patients.”
The report said effective alternatives to hospital admission must also be found, including better managing people in their own homes or other community settings.
And it calls for all doctors to feel responsible for the quality of basic care given to patients - for example hydration - and “take action whenever they become aware of this being inadequate”.
New roles will be created in hospitals, according to the proposals, with a chief of medicine having ultimate responsibility for all adult patients and a new “buck stops here” approach.
A new chief resident will work with junior doctors and help plan service design and delivery, including rotas, duties and workload.
The report said care should be organised so patients are reviewed by a senior doctor as soon as possible after arriving at hospital, and should see a specialist in their condition as soon as possible.
This might mean seeing multiple specialists for some patients, with care co-ordinated by a single doctor.
An “acute care hub” in the hospital will focus on accommodating patients for up to 48 hours and consultants from a range of specialties will spend time here to offer expert opinion.
A separate “clinical co-ordination centre” will act as a control room for real-time patient information, handover and transfer briefings, and organisation of care for all acutely ill medical patients , whether inside or outside the hospital.
Dr Cliff Mann, president of the College of Emergency Medicine, said: “This report has major implications for emergency medicine. The emergency department is reliant on comprehensive medical services from a range of other specialties.
“The implementation of this report will be a challenge - but we agree that it must be addressed. Unifying and integrating the hospital and wider healthcare facilities, including those related to primary and social care will benefit the care for our present and future patients.”
Peter Carter, chief executive and general secretary of the Royal College of Nursing, said: “The Future Hospital Commission looks at some of the most pressing challenges facing the NHS, including rising emergency admissions and how to provide better care for patients with increasingly complex conditions.
“The commission rightly focuses on a patient-centred approach to care, and the smooth and safe transfer of patients from hospitals to the community,2 he said. “Nurses play a vital role in delivering community services so are perfectly placed to work with patients, their carers and other agencies to help keep people as healthy as possible and out of hospitals.”
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