A report published by the think tank Reform this week has warned that the NHS will need £5bn of extra funding by 2013, to prevent the closure of as many as 40 hospitals. Inevitably, it is this worrying prognosis that has grabbed the attention of the national press, but there is a far more interesting and important message in the report. Entitled “The hospital is dead, long live the hospital,” it calls for the radical reform of hospitals themselves.
Recent discussions of NHS reform have overlooked fundamental questions about how hospitals should be run, concentrating instead on competition and the introduction of market forces. These are at the centre of Andrew Lansley’s reforms in the Health and Social Care Bill as well as the changes that the Labour government made in 2006. Reform’s report moves beyond these concerns. Entirely new “business models” that re-shape the way hospitals provide services, it says, could be the key to provision that is better value and better suited to our changing health needs. Crucially we need a model that will avoid funding shortfalls like the one they predict for the current government.
One suggested model, the "solution shop" model, involves reorganising hospitals around “disease groups,” rather than traditional specialisations. Thus, a patient will be passed to a specific, diverse group of specialists who deal with a specific problem set—the solution shop for intestinal disease, for example, would include colorectal surgeons working alongside gastroenterologists rather than in different departments. This could prevent patients being moved from department to department during the diagnosis process, which wastes both time and valuable resources.
Another issue raised by the authors is the need for new, community-based arrangements catering to those suffering from the long-term or chronic conditions that will become increasingly common as our population ages. Such hospitals could develop community networks orientated to the long-term outside of their walls rather than giving up their resources in the short term in the form of beds, which is much more costly.
As they recognise, this is a reform project that is rarely discussed: “it would be politically naïve to expect any political party…to consciously admit to the public that they were engaged in a reform programme that was going to radically convert hospitals from their current use,” they, quite rightly, say. It may, however, be a more palatable alternative to the government’s current line. As an editorial leader in today’s Guardian points out, the government’s “grand scheme” for the NHS is misplaced when what is needed is “sound management.” Rethinking infrastructure may be less politically naïve in the long-term than the report’s authors realise.
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