A number of suggestions of a short term nature to cover the prolonged manpower shortages… rationing by underprovision. Every patient deserves an examination, and the doctor deserves the opportunity to do the examination if he so wishes. I predict that risk averse hospital doctors will avoid this suggested method of working…But there are just a small proportion of GPs who might well cope. A no fault compensation scheme would help…. as there could be even more litigation. This suggestion is certainly not “patient centred” or “good news”. Rural areas, where services are already poorer, will be affected more than cities.
Local hospitals must reinvent themselves through forming chains, offering appointments on Skype or merging with GP services in order to survive, the NHS economic regulator has said.
Smaller hospitals are feeling the tightest budget squeeze and must not opt for “business as usual”, according to a report by Monitor, which oversees health service finances. It urges them to find better solutions than closing or merging with other hospitals.
The warnings echo guidance from Simon Stevens, chief executive of NHS England, who has urged local health chiefs to experiment with unusual ways of organising care, with chains — where hospitals around the country standardise care and share back-office functions — and link-ups with GP services emerging as favoured options.
David Bennett, chief executive of Monitor, said that he was increasingly concerned about the worsening finances of smaller hospitals, citing a growing fear that the district general hospital model might be unsustainable.
Hospital budgets have been squeezed as the NHS tries to make £20 billion of efficiency savings at the same time as recruiting nurses and offering more services seven days a week. Dr Bennett said: “A lot of early evidence suggests that this is going to become a more serious problem. The requirements of moving to things like 24/7 cover, raising nurse staffing ratios and so on are going to increase these pressures.”
Nigel Edwards, chief executive of the Nuffield Trust think-tank, said: “The real issue is whether you can afford the number of staff you need to deliver a seven-day-a-week consultant-led service. Smaller hospitals have less work to spread that cost over. I think this is going to fundamentally change the model of the local hospital in a lot of ways.”
Mr Edwards said that one option would be for local hospitals to become “a bit like the ground floor of Debenham’s with concessions on it”, with contracts to bring in experts from larger hospitals when patients needed it.
Dr Bennett said: “It seems pretty certain pressures are going to grow and there needs to be a response to that. I don’t think that response is only about mergers and it’s certainly not about closing hospitals.”
He suggested that hospitals take over responsibility for looking after elderly patients at home, helping to keep them out of expensive hospital beds. Monitor also wants to see more use of videolinks so senior staff can work across different hospitals and see patients remotely.