It has been a recognised fact for many years now that we live in an era where people are living longer and not doing so healthily and pressure continues to build on healthcare systems around the world as a result. Although, on Thursday, I read a BBC report which talked of hospitals on the brink of collapse as a result of bed closures and over population by elderly patients, and on top of that doctors under extreme pressure due to staff shortages.
I’m not sure this is new news however, and I’m wondering why these results have only just materialised in a Royal College of Physicians report? It appears to be a very well timed political message directed at the new health secretary to act now, covertly saying “there’s opportunity Mr Hunt to make a positive impact from the start by listening to the coalface, rather than proceeding steadfast against some of the ill thought-through elements of the Lansley plan.” Just a thought!
Aside to many hospitals in deficit crises, those in administration or those merging, we now see the headlines emerge of ‘hospital collapse’. Why are parallels not being drawn between the two issues: Further radical shake-up is needed because in actual fact these issues are all occurring due to the extreme pressures put on hospitals to saddle the brunt of healthcare delivery in this country.
Although, with the advent of the Clinical Commissioning Groups (CCGs) perhaps we will begin to see a start to things changing, particularly if services configuration is top of their lists! We’re told that the critical success factor to the new PCTs by another name (sorry for the cynicism) is clinical involvement and direction, in particular GPs, but I am hearing that representation by acute clinicians is low. This had better change though to ensure the voices of our hospitals are heard first hand as they pertain to their localities. Another interesting fact I read the other day was in a report from Leeds University Business School that stated the UK has one of the lowest percentages out of all healthcare systems in terms of clinical managers on hospitals’ boards – at 58% – whereas 74% representation exists in the US and a whopping 93% in Sweden. Perhaps we should take heed!
Anyway, back to hospital capacity issues. Now unlike the US where 45,000 people die every year because they don’t have health insurance and are denied treatment, the NHS is there to ensure everyone gets treated irrelevant of ability to pay. Trouble is, if people aren’t turned away, and we have an aging unhealthy population, the cracks will appear if the system stays the same and the default remains the hospital! So what needs to change? Well of course no one should be denied healthcare and while we have an NHS that will not happen, but again, it boils down to service configuration and the urgent need for reconfiguration.
Configuration must be based on categoric local patient evidence, the prevalence of certain diseases backed by medical evidence and best practice guidelines; this coupled with forward looking planning based on trend analysis. Supposition appears to be the way it’s being done, that, and good intentions.
The thing is that technology exists that can support the decision making process; and in almost real-time rather than retrospectively based on the likes of HES data. Straightforward tools that can support local population modelling against disease prevalence and trending exists, assessment tools to determine appropriate level of care as well as support for risk stratification and are also proven and readily available; not forgetting most importantly, referral management decision support software.
So although the issue remains for the time-being that there are not enough beds in hospitals, I do hope that the priority for CCGs when they take hold of budgets in April 2013, will be to make tough choices around service configuration and to base it on local need and real evidence. The tools already exist that will help them to make those informed decisions.