Holby- style hospitals on casualty list as closures loom
The district general hospital - epitomised in the television series Holby City - may soon become a relic of the past as patients turn to private providers for their healthcare, according to a top-level report being prepared in Whitehall. The likely end of the district hospital underlines the scale of change in the National Health Service as it adapts to government reforms.
More private providers of non-emergency care and the shift of more care and diagnosis outside hospital means "the current configuration of acute hospital services is likely to be unsustainable in many parts of the country", according to a late draft of the report seen by the Financial Times.
The report, being compiled for Sir Nigel Crisp, NHS chief executive, and Patricia Hewitt, the health secretary, in effect heralds the end of the provision of at least one main hospital in every town, offering all but the most specialised services.
Instead, fewer hospitals will have a full accident and emergency service, more care will be delivered by networks of hospitals, and key staff are likely to have to work across institutional boundaries, says the report.
The pressures for change will become "irresistible". If services do not adapt "they risk becoming unsustainable, unsafe, unstaffable, and unpopular" which in turn will result in "service failure", the draft adds.
It is being drawn up for the National Leadership Network, an advisory body of top NHS figures set up by Sir Nigel and supported by a Department of Health secretariat. A department official said: "This is a draft report of advice to ministers. It is not departmental policy."
But senior NHS managers are already acknowledging the scale of the change. Neil Goodwin, chief executive of the Greater Manchester Strategic Health Authority, told a conference this month that what is under way is "the death of the district general hospital as we have come to know and love it".
That posed a big challenge "to national and local politicians and to NHS management. They will have to explain in a very clear and sophisticated way how hospital services are going to be delivered in future, against a backdrop of dramatic consumer and technologically driven change", he said.
The report says the local hospital will continue to play a crucial role. But competition between providers is likely to take much routine surgery out of some hospitals, and not all hospitals will be left with the "core" services needed to support trauma and emergency surgery. That is likely to have to be managed across networks in fewer hospitals.
The ambulance service will play an expanded role in providing immediate care and taking key decisions on where people are taken for treatment, and "there will be much greater diversity of service provision between local hospitals than has been allowed for under the old district general hospital model".
The draft report adds: "A crucial challenge will be to ensure that the future vision for acute hospitals is financially sustainable, especially as the NHS transitions from its current period of expansionary funding to a steady state of lower annual growth."
The big shift raises important questions about medical and other training and where it will take place, the report says. "Considerable work is still required to improve service integration . . . especially in the area of urgent and emergency care, paediatrics and maternity services."
Its findings follow warnings earlier this year from Bob Ricketts, head of capacity planning at the health department, that there was "an increasing threat to the viability of the districtgeneral hospital" and the shift of care outside hospital and to private providers could produce the "hollow hospital".
http://news.ft.com/cms/s/13500c5a-5c8f-11da-af92-0000779e2340.html
More private providers of non-emergency care and the shift of more care and diagnosis outside hospital means "the current configuration of acute hospital services is likely to be unsustainable in many parts of the country", according to a late draft of the report seen by the Financial Times.
The report, being compiled for Sir Nigel Crisp, NHS chief executive, and Patricia Hewitt, the health secretary, in effect heralds the end of the provision of at least one main hospital in every town, offering all but the most specialised services.
Instead, fewer hospitals will have a full accident and emergency service, more care will be delivered by networks of hospitals, and key staff are likely to have to work across institutional boundaries, says the report.
The pressures for change will become "irresistible". If services do not adapt "they risk becoming unsustainable, unsafe, unstaffable, and unpopular" which in turn will result in "service failure", the draft adds.
It is being drawn up for the National Leadership Network, an advisory body of top NHS figures set up by Sir Nigel and supported by a Department of Health secretariat. A department official said: "This is a draft report of advice to ministers. It is not departmental policy."
But senior NHS managers are already acknowledging the scale of the change. Neil Goodwin, chief executive of the Greater Manchester Strategic Health Authority, told a conference this month that what is under way is "the death of the district general hospital as we have come to know and love it".
That posed a big challenge "to national and local politicians and to NHS management. They will have to explain in a very clear and sophisticated way how hospital services are going to be delivered in future, against a backdrop of dramatic consumer and technologically driven change", he said.
The report says the local hospital will continue to play a crucial role. But competition between providers is likely to take much routine surgery out of some hospitals, and not all hospitals will be left with the "core" services needed to support trauma and emergency surgery. That is likely to have to be managed across networks in fewer hospitals.
The ambulance service will play an expanded role in providing immediate care and taking key decisions on where people are taken for treatment, and "there will be much greater diversity of service provision between local hospitals than has been allowed for under the old district general hospital model".
The draft report adds: "A crucial challenge will be to ensure that the future vision for acute hospitals is financially sustainable, especially as the NHS transitions from its current period of expansionary funding to a steady state of lower annual growth."
The big shift raises important questions about medical and other training and where it will take place, the report says. "Considerable work is still required to improve service integration . . . especially in the area of urgent and emergency care, paediatrics and maternity services."
Its findings follow warnings earlier this year from Bob Ricketts, head of capacity planning at the health department, that there was "an increasing threat to the viability of the districtgeneral hospital" and the shift of care outside hospital and to private providers could produce the "hollow hospital".
http://news.ft.com/cms/s/13500c5a-5c8f-11da-af92-0000779e2340.html
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