This document outlines a vision for the future of clinical care in hospitals, with three key points: 1) It describes the changing needs of patients in the 21st century, with more elderly patients living with multiple chronic conditions. 2) It proposes a vision for the future hospital that focuses on integrated care across health and social services, continuity of care, and specialist medical teams. 3) It discusses early examples of realizing this vision through programs like front-door geriatric assessments and ambulatory emergency care, and outlines challenges and strategies for further development.

1. The Future Hospital:
A new vision for clinical care
Nuffield Trust June 9th 2014

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. 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. 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. 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. 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. 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. ….

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. 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. 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. 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. 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. Programme Themes
Patient centred care
Quality, standards, & data
Education, training, CPD and
support
Workforce planning
Academic Medicine & Research
Organisational development
Development
sites

15. Double GP training places
2015
3-4% growth consultant
workforce
Run through emergency
medicine training
Additional 75 ACCS posts
HEE

16. Broad based training
Acutely ill patients
Fit to practise at graduation
Registration at graduation
Pt involvement
Generic capability framework
HEE

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

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

19. 15% cut in real terms since 2010