A new report from the Future Hospital Commission recommends that in future, care should come to the acutely ill patient, rather than the patient being moved around the hospital.
This is one of 50 recommendations aimed at improving care for acute medical patients in Future Hospital: Caring for medical patients, which puts the patient experience and the concept of ‘clinician citizenship’ back into the very heart of healthcare. This is matched with a radical restructuring of the wards where acutely ill patients are treated, and a new organisational and management structure whose responsibilities for acutely ill medical patients will stretch out from the hospital into the wider community, developing the idea of a local healthcare system.
The independent Future Hospital Commission was established by the Royal College of Physicians in March 2012 to find solutions to the current challenges facing the NHS – a rising tide of acute admissions, the increasing number of patients who are frail, old, or who have dementia, patients with increasingly complex illnesses, systemic failures of care, poor patient experience, and a medical workforce crisis.
The Commission brought patients and medical and healthcare experts together to develop a vision for the Future Hospital covering both how patients should be cared for, and the changes in organisation and staffing that would support the new vision. The Commission sought out and benefited from best practice examples of care in England, that are included in the report. The report recommends:
For patients – a new focus on patient experience, principles of patient care, communication, information and responsibility
- Care should come to the patient, and the patient should not be moved unless it is absolutely necessary for their care.
- The patient experience should be as important as their clinical outcomes.
- Patients should be treated with kindness, respect, and dignity, and their privacy and confidentiality should also be respected – a locally determined ‘citizenship charter’ would tie health workers to this concept.
- Patients should be fully involved in decisions about their care, with an emphasis on supporting self-care, autonomy and health promotion.
- Who is responsible for each patient’s care on any given day, seven days a week, should be clear to the patient, their relatives and carers, and this team should be led by a named consultant working with a nurse ward manager.
- Patients should no longer be ‘discharged’ – planning for their future care needs and transfer to intermediate, community, primary, or social care, within a healthcare system, or their return home, should begin on admission.
- Patients should be assessed and diagnosed by a senior doctor on admission, and should see a specialist in their condition as soon as possible. This might mean seeing multiple specialists for some patients, with care coordinated by a single doctor.
- Acutely ill patients should have access to the same medical care at weekends as on weekdays.
- Continuity of care should be the norm, with an emphasis on excellent communication in relation to transferring the care of patients to new medical teams or new settings when their needs demand it.
Structure and organisation – bringing together disparate parts of medical care under one management and organisational structure which for the first time, with specialist medical teams working with partners in primary and social care to support patients o
- A new medical division in each hospital caring for medical patients, with care responsibilities that reach outside the hospital into the wider health community.
- A new Acute Care Hub which will include the acute medical unit (AMU), short-stay wards, enhanced care beds (level 1) and ambulatory emergency care (AEC).
- A Clinical Coordination Centre which will act as a central control room for real-time patient information, handover and transfer briefings, and organisation of care for all acutely ill medical patients , whether inside or outside the hospital.
Workforce – new roles and responsibilities for doctors caring for acutely ill patients, both entirely new roles and changes to the working patterns and responsibilities of other doctors within the hospital
- A new role – the chief of medicine – will have ultimate responsibility for all adult patients with a medical illness and a new ‘buck stops here’ approach.
- A new role – the chief resident – responsible for liaising with junior doctors in the Medical Division and help plan service design and delivery, including rotas, duties and workload.
- Consultant physicians in medical specialties will spend time in the acute care hub, providing specialist opinion and care.
- Increased roles for both ‘generalist’ and specialist physicians:
- more ‘generalists’ – doctors skilled in the diagnosis and management of acutely ill emergency patients or those with complex medical needs already in hospital – will be needed to better manage these patients across the hospital and in the community
- seeing the right specialist as early as possible improves patient care and recovery, and specialist physicians will need to spend more of their time supporting ‘generalists’ in the acute care hub.
Sir Michael Rawlins, chair, Future Hospital Commission, said:
This report has major implications for the clinical practice of physicians, the training of future generations of physicians, for research and, most importantly of all, for patients. Its implementation will be a challenge for us all, but implement it we must. Our present and future patients will expect – indeed demand – no less.
Professor Tim Evans, Lead Fellow for FHC said:
I hope this report will represent a template which can be adapted to the needs of patients in different geographical locations, and improve both their care and their medical management. We feel this will be achieved fully only where the hospital and wider healthcare facilities, including those related to primary and social care, are unified in their vision and integrated in its execution.