These are two of the proposals made in a new paper from Social Market Foundation think tank, in which healthcare experts argue for swift action and a shift to a whole new model of care.
In ‘A new lease of life: Three steps to success for the NHS’, Nick Bosanquet, former Professor of Health Policy at Imperial College, and Andrew Haldenby, an experienced adviser to public service organisations, set out a GP-led plan for a more efficient NHS, which would involve replacing the traditional general hospital model to improve outcomes and reduce cost pressures.
The paper further argues that the £20bn New Hospital Programme (NHP) should be scrapped and its funds diverted to invest in the necessary changes. It highlights the NHP has been best by delays and rising costs, and ultimately only replaces existing beds. The Labour Party has already signalled that it will review this investment if it comes to power.
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.
What would the new model look like?
The new model of care would feature teams led by GPs comprising health professionals including physiotherapists and counsellors, who would manage all out-of-hospital services in an area. The aim would be to reduce hospital admissions over time; these Neighbourhood Teams would be tasked with reducing hospital admissions by 30% in 10 years. The Neighbourhood Teams would be complemented by ‘Dynamo Centres’ which would offer more operating capacity than surgical hubs and, the paper recommends, should be modelled on the South West London Elective Orthopaedic Centre, which is rated among the best in the country.
These Dynamo Centres 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.
The remaining District General Hospitals would then be left to focus on providing A&E services, and work with Neighbourhood Teams.
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.
Further, Integrated Care Systems should be given control over their capital spending, with dedicated funds for maintenance and development that can be carried over from one year to the next.
Jamie Gollings, Deputy Research Director at Social Market Foundation says: “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 pre-empt and avoid it.”