Anita Donley: A new vision for clinical care


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Anita Donley: A new vision for clinical care

  1. 1. The Future Hospital: A new vision for clinical care Nuffield Trust June 9th 2014
  2. 2. The need for a new vision of clinical care • Rising clinical demand • Changing needs • Fragmented care • Out-of-hours care breakdown • Medical workforce crisis
  3. 3. 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 ?
  4. 4. 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
  5. 5. 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
  6. 6. 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
  7. 7. 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’
  8. 8. ….
  9. 9. 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.
  10. 10. 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
  11. 11. 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
  12. 12. 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,
  13. 13. 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
  14. 14. Programme Themes Patient centred care Quality, standards, & data Education, training, CPD and support Workforce planning Academic Medicine & Research Organisational development Development sites
  15. 15. Double GP training places 2015 3-4% growth consultant workforce Run through emergency medicine training Additional 75 ACCS posts HEE
  16. 16. Broad based training Acutely ill patients Fit to practise at graduation Registration at graduation Pt involvement Generic capability framework HEE
  17. 17. Hard Truths “ Targets or finance must never again be allowed to come before quality of care”
  18. 18. 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
  19. 19. 15% cut in real terms since 2010