NHS trusts — types of hospital < Influencers contents | Print this page Hospitals and their changing environment NHS influencers should be aware that the hospital environment currently contains a number of drivers for significant change:
It is likely that we will continue to see NHS trust mergers and hospital closures will be sure to follow. Reconfiguring hospitals The DH has set in train a programme of work to provide support to NHS organisations and local authorities considering the development and configuration of acute hospital services. A framework for re-configuring hospitals, setting out a proposed approach for assessing configurations and possible options for models of care (including providing care closer to home), has been published. Keeping the NHS local: a new direction of travel sets out guidance for the NHS on service change ‘to help local NHS organisations to work in a new, stronger partnership with the public, staff, and other key stakeholders to find high quality, sustainable solutions for local services, and deliver the agenda for reform.’ The document describes some service models to promote further discussion and debate. The issue of reconfiguring hospitals is a sensitive one for a government anxious to avoid controversy of the sort that saw Kidderminster hospital campaigner Dr Richard Taylor elected as MP for Wyre Forest in 2001, unseating a government minister. The problem is that reconfiguration has a bad name in the NHS and more importantly in local populations, as it has become synonymous with closure and centralisation of services. The huge Paddington Health Campus hospital redevelopment is set to be cut in size by some 15 per cent — see St Mary’s NHS trust. This is interesting as comments made suggest that the scheme may need to be reduced in size so that the stakeholders are now ‘working towards a different model of care, where ambulatory care and CDM are better managed in community settings’. Nearly two thirds of the latest PFI projects announced will see significant investments in the community as well as acute services. For instance the north Mersey future healthcare programme will see the closure of all psychiatric wards in the acute sector and their replacement with five mental health resource centres in community settings, probably unique in the country. And in Sandwell and West Birmingham the new developments include community- based alternatives to hospital care. The run-up to the expected May 2005 general election had begun early when the shadow of elections fell over redevelopment plans at both Whittington/Royal Free hospitals and at Hartlepool. In north London plans to reshape children’s and maternity services were blocked by the DH amid fears of negative publicity ahead of a general election. Proposals agreed by PCTs for consultation, were thrown into disarray when SHA chief executives were told that a ‘negative consultation’ before an election would be ‘unacceptable’. In Hartlepool plans to reshape health services were put on hold after John Reid intervened just before the by-election, saying that the hospital would remain open ‘as long as I am Secretary of State’. This despite government saying that they ‘were letting go’ and the NHS Confederation urging managers to demonstrate the ‘courage of their convictions’ by resisting political interference as hospital redesigns increasing came under the spotlight. Growing capacity: a new role for external healthcare providers in England Overseas clinical teams and providers are being invited into the UK to address the capacity crisis in the NHS acute sector. Two distinct roles for overseas healthcare providers in the NHS seem to be emerging. US health maintenance organisations like Kaiser Permanente and United Healthcare (Evercare) are being used to improve the performance of PCTs, while European healthcare organisations have been encouraged to boost NHS capacity by staffing, and maybe developing elective surgery units. The plans for the former were set out in Growing capacity: a new role for external healthcare providers in England. Kaiser’s work with a number of English PCTs involves improving information and management systems. It has particular expertise in chronic disease areas such as asthma and diabetes, where the growing consensus is that more could be done in a community setting to prevent hospital admissions. This has to be relevant to NHS influencers involved in these clinical areas. The PCT Evercare pilots have been using advanced nurse practitioners as case managers in the elderly. There is a sense of déjà vu here, with shades of disease management and managed care, which pharmaceutical companies like Lilly, GSK and Novartis attempted to introduce in the mid-90s and then abandoned. Pfizer has already made a move in this area with Pfizer Health Solutions, a wholly owned company of Pfizer Inc, already running a disease management pilot with Haringey Teaching PCT.
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