The crisis in the NHS, with unacceptable waiting lists and ever increasing emergency admissions, shows the current model is failing to meet modern healthcare needs. This briefing proposes a new model to increase efficiency, shifting care away from the district general hospital towards fewer, specialist teams, more neighbourhood care and greater transparency.
KEY POINTS
- The status quo in the NHS is untenable: waiting lists are unacceptable, experienced staff will be in shorter supply, bed numbers are likely to remain static.
- Despite fatalism in some quarters, previous experience shows productivity can be increased in healthcare: early diagnosis and testing kept HIV/AIDS under control, mortality rates from coronary heart disease have fallen dramatically and the cost and length of stay for hip and knee replacements has fallen.
- Patterns of demand for healthcare have shifted, with the number of patients with long term conditions like respiratory, cardiac, diabetes and anxiety/depression set to rise from 5.3 million in 2020 to 9.1 million in 2040.
RECOMMENDATIONS
- The NHS should move away from the district general hospital model and replace it with ‘Dynamo centres’, delivering acute services in fewer locations.
- This could improve productivity by 20%, making more efficient use of specialists’ time, and reducing the overall number of hospital beds and staff.
- It should invest in integrated neighbourhood teams, which maintains continuity of care and is more cost effective than hospital-based care, and could reduce admissions by 30%.
- Data on the costs and productivity of different services should be routinely collected and published to allow for diffusion of effective methods.
- Integrated Care Services should be given control over their capital spending, with dedicated funds for maintenance and development than can be carried over from one year to the next.
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