Westminster Think Tank, Re:State has published the final paper in its ‘Hospital of the Future’ programme. With the aim of rethinking the hospital system as if it was being designed anew today, this series of papers has made a series of recommendations to the Government about what is needed to enable transformation of the health service.
One of the core premises of the ‘Hospital of the Future’ programme is that an ‘upstream’ shift in care to prevention rather than cure will not on its own address the problems that hospitals are facing.
In the introduction to the final paper in the series, which pulls together all the findings and sets out conclusions, the Chief Executive of NHS Providers, Daniel Elkeles, and the Chief Executive of NHS Confederation, Matthew Taylor, describe it as a “crucial programme of work.” As the most expensive part of the system, hospitals must be at the heart of reforms to the NHS and how it operates.
They say: “This series is right to ask what should, and vitally, what should not, be delivered within the physical building – but to challenge the assumption that moving care into the community is automatically the right answer. It is right to ask what role technology can play – but to highlight that realising the benefits requires serious time and investment in change management and redesigning pathways and processes. And it is right to highlight the fundamental role that patient flow plays in maximising the efficiency and effectiveness of a hospital – but to challenge the idea that poor patient flow can be addressed without addressing workforce shortcomings.
“As Chief Executives of the two largest NHS member organisations who firmly believe that reshaping the hospital footprint can lead to better patient outcomes, a better staff experience and a more sustainable health system, we welcome this serious contribution to defining the hospital of the future.”
Aiming for change
The three previous papers in this programme began with a framing paper to summarise the problems and why they exist, followed by an examination of the hospital as a service, not a building, and then a deep dive into the problem of patient gridlock and how to end it.
The final paper sums up the key lessons learnt from the programme:
• The hospital should be understood as its own unit of analysis
• Hospitals should continue to reduce in size, not grow
• Technology will be foundational to the future of the hospital, but its value will not materialise organically
• Technology is only one part of system reform – funding, pathway and workforce reform are essential
• Effective management – operational, change, system – is essential for transformation.
There are also some harsh truths to be understood: that physically moving services into the community is not always preventative, cheaper or more productive; that hospitals must be careful when reducing beds to avoid unintentionally increasing service demand; and that automation and new ways of working could boost productivity and value for money, that doesn’t necessarily cut costs.
In the challenge of transforming the health service for the future, the aim is not to bring about minor improvements, but to make it work substantially better by operating differently. As Matthew Taylor and Daniel Elkeles state: “Inaction is not an option, and we hope this [programme] helps spark the most urgent conversation needed about the future one of the country’s most vital public services.”
