A coalition of health managers, clinicians, charities and patients’ representatives has proposed that the NHS in England needs to be more radical about closing some hospital services and diverting resources to more community-based care. The alternative to these reforms would be to face a “vicious” spiral of botched changes, it is alleged.
The latest report, by the NHS Confederation, Academy of Medical Royal Colleges and National Voices, makes the case for investing in community services. This means investing less in some hospital services. Too often, asserts this report, the health service has been reactive, “tweaking” services, instead of planning changes for more integrated care properly and systematically.
The “Changing care, improving quality: reframing the debate on reconfiguration” report identifies six principles for re-configuration planning:
- Healthcare is constantly changing: for example, the population is ageing; and there are innovative treatments.
- There are benefits to delivering new models of care: improving outcomes for patients.
- Reconfiguration is a general term embracing different types of change, each with different drivers and potential benefits.
- Patients and their organisations can co-produce better services: they should be engaged as equals to critique and re-design provision to meet their needs and preferences (aka “co-production”).
- Whole-systems approaches are needed: services cannot be tweaked in isolation. New models of care transcend traditional borders in healthcare.
- Change requires consistent strong leadership to develop change with the local community. Collaboration relies on strong relationships, built on trust and experience.
Six factors important for success are identified as:
- The system.
The main section headings in this document cover:
- Executive summary.
- The case for change.
- Meeting patients’ changing needs.
- Improving quality, safety and outcomes.
- Achieving better value.
- Challenges of reconfiguration.
- Getting access right.
- Getting resources right.
- Getting the system right.
- Getting leadership right.
- Getting communication right.
- Getting collaboration right.
Read more: BBC News. NHS ‘risks making mess of changes’.
Triggle, N. (2013). NHS ‘risks making mess of changes’. London: BBC Health News, June 5th 2013.
This relates to:
NHS Confederation (2013). Changing care, improving quality: reframing the debate on reconfiguration. London: NHS Confederation, June 2013.
Gently amusing, but ever thought-provoking. The latest parallel-universe commentary from NHS Networks, “Lack of Resources an Opportunity?” (NHS Networks), is included here for consideration; no-one has a monopoly on insight.
[A brief reference to this item features in Dementia and Elderly Care: the Latest Evidence Newsletter (RWNHST), Volume 3 Issue 9, August 2013].
Service Transformation: Lessons From Mental Health (King’s Fund)
A community-based care model for mental health services replaced the acute and long-term care provided by large institutions during the past 30 years. Planning for similar changes from hospital to community-based alternatives for physical healthcare in the United Kingdom might benefit from experience of the earlier parallel transformations in mental health services. The following analysis presents ten such lessons for service transformation.
Gilburt, H. Peck, E. Ashton, B. [et al] (2014). Service transformation: lessons from mental health. London: The King’s Fund, February 4th 2014.
Community Services: Transforming Care (King’s Fund)
The following document explores the potential of community services for transforming care.
Edwards, N. (2014). Community services: how they can transform care. London: The King’s Fund, February 13th 2014.