A think tank has a radical plan for the NHS: scrapping the hospital model of care
What do you think about these proposals?
The NHS should replace its traditional general hospital model to improve outcomes and reduce cost pressures, a new report from a think tank says. Its authors say the government is using “strikes as a convenient excuse” for the chaos in the NHS. So, the Canary would like to hear your thoughts on the plans.
NHS: time for a radical change?
The proposals come as part of a paper published on Thursday 25 January by the centre-left think tank the Social Market Foundation. It’s authored by Nick Bosanquet, former professor of health policy at Imperial College, and Andrew Haldenby, an experienced adviser to public service organisations. You can read the report here.
Together, they set out a plan for what they claim will be a more efficient NHS, featuring teams led by GPs and including physiotherapists, counsellors, and specialist ‘Dynamo’ operating centres, with the goal of making many trips for hospital treatment obsolete: 30% fewer NHS patients should be attending hospitals in 10 years’ time, the paper proposes.
The government’s £20bn New Hospital Programme, which entails building 40 new hospitals in England, has been beset by delays and rising costs, and largely replaces existing beds, the paper highlights. The Labour Party has signalled that it will review investment into the New Hospital Programme.
Swift action is needed
Bosanquet and Haldenby argue that it should be cancelled and its funds used to invest in a modern hospital system. As the report points out:
- The NHS is losing public and professional confidence: waiting lists are unacceptable, experienced staff will be in shorter supply, bed numbers are likely to remain static.
- Previous experience shows productivity can be increased in healthcare: early diagnosis and testing kept HIV/AIDS under control, mortality rates from coronary heart disease have fallen dramatically and the cost and length of stay for hip and knee replacements has fallen.
- Patterns of demand for healthcare have shifted, with the number of patients with long term conditions like respiratory, cardiac, diabetes and anxiety/depression set to rise from 5.3 million in 2020 to 9.1 million in 2040.
The proposals in the report say that a modern system would feature a local GP-led teams – a team of health professionals managing all out-of-hospital services in an area, with the aim of reducing hospital admissions over time. These ‘Neighbourhood Teams’ would be tasked with reducing hospital admissions by 30%.
Without swift action, the paper suggests, the NHS is drifting towards a three-tier system: worst in deprived areas, better in affluent areas, and with more people buying private care.
Maintaining the district general hospital model prevents policymakers from addressing Britain’s changing health needs, and obstructs the NHS from making necessary efficiencies.
A new path for the NHS?
A patient could be treated by their neighbourhood team of healthcare professionals at home, resulting in a more cost-effective outcome than hospital-based care, with the potential to treat four times as many patients in a month.
Neighbourhood Teams would also maintain continuity of care, which is becoming a more important requirement, given the rise in long term conditions which have physical and mental health elements.
Neighbourhood Teams would be complemented by “dynamo centres”, with more operating capacity than the new surgical hub units – and should be modelled on the South West London Elective Orthopaedic Centre (rated “among the best in the country”).
These would be highly specialised, and treat a large enough area such that 24/7 staffing by consultants would be viable. The specialisation and concentration would boost output and success rates, ultimately bringing down waiting lists.
Remaining district general hospitals would then be left to focus on providing A&E services, and work with Neighbourhood Teams.
Government using “strikes as a convenient excuse”
Bosanquet said:
The NHS’s enormous current resources can deliver a faster, better service within months, even in a climate of great pressure on public spending.
Haldenby said:
Ministers are using strikes as a convenient excuse for rising waiting lists. The NHS has talked about the right kind of change for years but progress has been glacial.
Jamie Gollings, Deputy Research Director at Social Market Foundation said:
Addressing Britain’s changing healthcare needs whilst delivering better value for public money is challenging, but possible.
The plan Bosanquet and Haldenby lay out requires great political will to shift our focus away from the traditional hospital model, but there are existing examples to learn from that show how it can be changed. Their paper shows how we can build greater and swifter operating capacity and deliver more healthcare in the community, and cut our losses on the increasingly delayed and burdensome New Hospital Programme.
The hospital must become a last resort for patients, and they must have avenues for care that preempt and avoid it.
What do you think of the Social Market Foundation’s proposals? Write a letter for us to publish – email membership(at)thecanary.co
Featured image via NHS England – YouTube
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Get rid of all the private sectors of the NHS giving back control of it’s monies
We lost control of healthcare in 2012 with Lansley’s Health and Social Act. There was an attempt to recover it with the NHS Reinstatement Bill (thank you Allyson Pollock and Peter Roderick – a brave attempt) but it was twice talked out by the Tories. Far too much is going on behind closed doors or deliberately unreported by a cowed BBC. Our two major parties turn out to be part of the same bag of tricks that has more to do with the plans of the wealthy Davos crowd than the ordinary taxpayers of this country. Shame on them. If we don’t stand up to the kind of ‘herding’ that is going on, worse is sure to follow.
First, I live in Scotland, so the model used by the researchers is not directly applicable. Nevertheless, most proposals can be adapted in various ways to fit the different and differing conditions, where population density is much different, with high concentrations in the Central Belt between Glasgow and Edinburgh and much lower densities in the Highlands and Islands which also include quite difficult terrains.
Given these population densities and the distances involved – and remember, Scotland’s land area is not much smaller than England’s, but the distance between Edinburgh and Shetland, for example, is greater than the distance between Edinburgh and London – a much more localised system is required and one which is locally empowered, but with relatively rapid access to specialised centres in place like Aberdeen, Inverness, Dumfries, Galashiels as well as Glasgow and Edinburgh.
Low population densities leads to issues in recruitment and retention of staff in low density areas. While many people positively choose to live in such areas and have over the years contributed significantly to the communities, longer term, there is a drift of people from them to the cities, largely due to the costs of affordable housing, lack of public transport and employment prospects. So, for much of Scotland reorganisation of health care services is just a part of a wider political issue of devolution of powers and funds from the larger centres of population to the more sparsely populated. However, in the urban areas, as the report indicates for England, there are significant resource disparities between affluent and less affluent areas which are often cheek by jowl. So, within the urban areas there is a need for a redistribution of resources and power from the more affluent to the les affluent.
One of the lessons from the pandemic was the value of the local community in supporting others within the community. It was heartening to se how spontaneously this assistance was given. If we can develop empowered local communities, in towns and cities, too, then we can create an ethos for the kind of community based NHS which the article envisages.