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P
4
romote public health through evidence-based legislation
Government must support local prevention and recovery
services combined with national leadership on public health,
social disadvantage and inequality. National levers like
legislation should be used where there is evidence to
support their use, such as: for smoking, the introduction of
standardised packaging; for excessive alcohol consumption,
the introduction of a minimum unit price for alcohol of 50p
per unit; and for obesity, taxes on sugary soft drinks.
>
romote innovative models of integration
P
Give local communities flexibility to develop radical new
models of joined-up care for patients. This should be
supported by evaluation of what works in different local
circumstances.
>
ake shared outcomes the norm
M
Actively promote shared outcomes that span their local
health and care economy in government health policies.
This should be reflected in the national mandate to NHS
England. Many patients long-term health is dependent on
a range of providers rather than the performance of a single
organisation.
boards.
Increase secondary care involvement in service
planning. People with knowledge of secondary care should
be represented in new structures introduced by the Health
and Social Care Act, including health and well-being boards.
There should be ongoing support to develop the new roles
introduced by the Act, such as secondary care doctors on
clinical commissioning group governing bodies.
Promote understanding of new structures.
Government must promote understanding of the
functions and accountability of new bodies such as clinical
commissioning groups.
>
se payments to drive collaboration
U
M
>
ake payments patient centred
>
se information to revolutionise care
U
Make a national commitment to promoting the adoption
of electronic patient records based on common record
standards. This would improve care for individual patients,
increase understanding of how the system operates, and
enable the development of more sophisticated ways of
measuring outcomes and targeting payments.
> B
uild capacity
Publicly support a maximum bed occupancy of 85%. Current
bed occupancy rates are often greater than 90%, and
investment is needed to change this. When hospital beds are
scarce and staff are stretched, patients are shunted around
wards and less likely to get better. Patients should be able to
receive care in the place where their needs can best be met
not the only available bed.
Investing now will help us save in the long term. Establishing a new
transformation fund would help hospitals and care partners to
transform the way they deliver care. Providing disjointed care for
patients is inefficient. It leads to unnecessary hospital admission,
increased lengths of stay in hospital, and delays in diagnosis,
treatment and recovery. When hospital beds are scarce and staff
are stretched, patients are shunted around wards. Investing in
capacity and staff health and well-being will support patients to get
better quicker. Investing in research and medical education now will
help to develop innovative new treatments and technology, and
improve the way we care for patients in the future.
NHS England
>H
arness clinical leadership
Promote clinical leadership and clinically led quality
improvement projects. The next government should provide
public and financial support for professionally led quality
improvement projects and leadership work. Such schemes
drive up quality and offer patients and carers, politicians,
policymakers, service planners, providers, commissioners
and regulators a robust badge of quality. Investigation of
which improvement strategies work best, a concept known as
improvement science, has the potential to transform the NHS.
> S
how national leadership on inequality
Commit to joined-up, national action on health inequality
by introducing a new health impact duty. There should be a
mandatory requirement for ministers to consider the health
impact of policies and decisions. There should be specific focus
on the potential impact on access to healthcare and disparity in
health outcomes. Expertise in healthcare and public health will
support these assessments and promote best value, effective
investment and prioritisation and a population health approach.
Measures to promote better care for vulnerable people, including
homeless people, should be supported at national level. This
should include measures to promote parity of esteem between
physical and mental health.
> R
emove barriers to specialist care
Remove barriers to timely access to specialist diagnosis and
treatment. Disincentives to prompt referral or the delivery of
specialist medical care outside the hospital building must be
removed. Patients who need specialist medical care should
get it promptly: delays in access to expert, specialist care harm
patients. Such delays can lead to failure to recognise worsening
asthma causing death, or delayed care of diabetic foot disease
leading to amputation.
Patients should have access to the care they need, when they
need it. Many patients can be managed well in primary care,
but most will need specialist help at some point. Some peoples
needs may be met by delivering specialist care in new ways
into the community. However, being admitted to hospital will
be essential for others. Barriers to accessing early expert care
must be removed. Specialist medical care should reach from
wards into the community. Swift access to expert diagnosis and
treatment improves outcomes for patients and can result in
long-term savings. Supporting patients to recover and manage
their conditions must be a priority in all policies.
>
ocus on patient experience, recovery and self-management
F
Make recovery and self-management a priority in all policies,
and drive improvement in patient experience. Rehabilitation,
reablement, recovery, self-management and patient
experience should be a shared priority for all health and care
services. Barriers to patients leaving hospital promptly, with
support, must be removed. Good practice should be shared at
national level and promoted in national policy.
>
are for patients who are dying
C
Commit to national action to support improvements in
end-of-life care. It is the core responsibility of hospitals to
deliver high-quality care for patients in their final days of life
and appropriate support to their families, carers and those
close to them. There should be national action to improve the
evidence base around recognition of dying, hydration and
nutrition, symptom control, and communication.25 Clinical
audits to ensure continued improvement in the care of dying
patients should be supported and promoted at national level.
The provision of care for the dying should be monitored by
national quality regulators, like the Care Quality Commission.
> P romote the Future Hospital model as a template for health
service redesign.
> T alk to local health and social care services about how
they are embedding Future Hospital principles.
> W
ork with us to remove barriers to delivering the
future hospital.
> H
elp us share good practice from Future Hospital partners
across the UK.
11
References
1 Alzheimers Society: Dementia 2013, infographic. www.alzheimers.org.uk/infographic
[Accessed: 14 August 2014]
2 Future Hospital Commission. Future hospital: Caring for medical patients. London: RCP, 2013.
3 Find out more about the Future Hospital model at: www.rcplondon.ac.uk/futurehospital
4 House of Commons Health Committee. Managing the care of people with long term
conditions. London: The Stationary Office, 2014.
5 Health and Social Care Act 2012. Duty as to promoting integration: Clinical
Commissioning Groups, Part 1, section 26 (14Z1); NHS Commissioning Board, Part 1,
section 23 (13N). General duties: Monitor, section 62 (4)
6 Future Hospital Commission. Future hospital: Caring for medical patients. London: RCP,
2013. Page 18.
7 Kings Fund. The NHS productivity challenge: experience from the front line. London:
Kings Fund, 2014.
8 Commonwealth Fund, 2014. www.commonwealthfund.org/publications/fundreports/2014/jun/mirror-mirror [Accessed 25 July 2014]
9 NHS England. The NHS belongs to the people: a call to action. London: NHS England, 2014.
10 Royal College of Physicians. Results, research panel survey July 2014. London: RCP,
2014. (Unpublished.)
11 Health and Social Care Act 2012. Duty as to education and training: Secretary of State,
Part 1, section 7 (1F). Duty as to promoting education and training: NHS Commissioning
Board, section 23 (13M); Clinical Commissioning Groups, section 26 (14Z).
12 Does NHS staff wellbeing affect patients experience of care? Nursing Times
2013;109:1617.
13 Sergeant J, Laws-Chapman C. Creating a positive workplace culture. Nursing
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14 Department of Health. NHS health and well-being: interim report. London: DH, 2009.
15 Department of Health. NHS health and well-being: final report. London: DH, 2009.
16 Kings Fund. Never again? The story of the Health and Social Care Act 2012. London:
Kings Fund, 2012.
17 The Marmot Review. Fair Society, Healthy Lives: The Marmot review. London: The
Marmot Review, 2010.
18 Royal College of Physicians. Passive smoking and children: a report of the Tobacco
Advisory Group of the Royal College of Physicians. London: RCP, 2010.
19 University of Sheffield, 2013. www.sheffield.ac.uk/polopoly_fs/1.291621!/file/julyreport.
pdf [Accessed 19 August 2014]
20 University of Stirling. Health First: An evidence based alcohol strategy for the UK.
University of Stirling: 2013.
21 National Heart Forum. Consultation response on front of pack nutrition labelling. London:
NHF, 2012.
22 Foresight. Tackling obesities: future choices. Project report. London: Foresight, 2007.
23 Information Centre. Health Survey for England 2006. London: Information Centre, 2008.
24 NHS Outcomes Framework Domain 2: Enhancing quality of life for people with long
term conditions. www.england.nhs.uk/resources/resources-for-ccgs/out-frwrk/dom-2/
[Accessed 14 August 2014]
25 Royal College of Physicians. National care of the dying audit for hospitals, England:
National report. London: RCP, 2014.
Get involved
The RCP will continue to develop the themes in
Future hospital: More than a building in the run
up to the UK general election in 2015.
To find out more, visit
www.rcplondon.ac.uk/morethanabuilding
To tell us what you think
or request more information email us at
policy@rcplondon.ac.uk