The NHS should replace its traditional general hospital model to improve outcomes and reduce cost pressures, a pair of healthcare experts suggest today.
The proposals come as part of a paper published today by the Social Market Foundation think tank by Nick Bosanquet, former Professor of Health Policy at Imperial College, and Andrew Haldenby, an experienced adviser to public service organisations. Together, they set out a plan (see Notes) for a more efficient NHS, featuring teams led by GPs and including physiotherapists, and 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 £20 billion 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.
Bosanquet and Haldenby argue that it should be cancelled and its funds used to invest in a modern hospital system. 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 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 (see Figure 1). 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.
Nick Bosanquet, Co-Founder of Aiming for Health Success and former Professor of Health Policy at Imperial College, 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.”
Andrew Haldenby, Co-Founder of Aiming for Health Success, 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.”
Notes
- The SMF briefing will be published at https://www.smf.co.uk/publications/a-more-efficient-nhs/ on Thursday 25th January 2024.
- The report offers a three-point plan for the NHS:
- The NHS should move away from the district general hospital model and replace it with ‘Dynamo centres’, delivering acute services in fewer locations. This could improve productivity by 20%, making more efficient use of specialists’ time, and reducing the overall number of hospital beds and staff.
- It should invest in integrated neighbourhood teams, which maintain continuity of care and is more cost effective than hospital-based care, and could reduce hospital admissions by 30%.
- Data on the costs and productivity of different services should be routinely collected and published to drive change in services and development than can be carried over from one year to the next.
- The briefing is published by the Social Market Foundation. The authors retain full editorial independence.
Contact
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