The Future Hospital Commission has released a new report outlining recommendations on how to improve care for acute medical patients, focussing on patient experience.
It addresses the poor coordination of care which often sees patients moved multiple times once admitted to hospital, calling for patients not to have to move beds unless absolutely necessary for their care.
This would see specialists visiting patients in general wards as opposed to patients being moved to specialist wards. Patients who see multiple specialists would have their care coordinated by one doctor.
The report also recommends that planning for future care needs should begin on admission, bringing to an end the concept of a patient being ‘discharged’. This would see closer working with teams in the community, with doctors and nurses running community clinics and visiting patients in their own homes, as already happens in palliative care.
Change to structures
Key to achieving this would be the creation of a Clinical Coordination Centre in every hospital, which would act as a central control room for real-time patient information, handover and transfer briefings, and organisation of care for all acutely ill medical patients, whether inside or outside the hospital.
As well as the formation of clinical coordination centres, other changes would see the introduction of a new Acute Care Hub, which would bring together the clinical areas of the hospital that focus on the patient’s initial assessment and stabilisation. This would make specific rooms available for practical procedures, discussions with patient and/or carers about sensitive medical decisions, as well as for palliative care.
There would also be more accountability within the new system, with a new Chief of Medicine taking ultimate responsibility for all patients with a medical illness.
Palliative care
In the section on responding to the needs of specific groups of patients, the report says the following about palliative care:
‘Patients who are dying need access to palliative care. For those with life-limiting illnesses, decisions about care escalation must be made before an acute deterioration occurs. The use of advanced care plans, developed in conjunction with the patient or, if incapacitated, with their
carers, is essential. Clinical decisions about ceilings of care, based on patients’ and carers’ wishes alongside projected clinical outcomes, need to be made, as well as decisions about resuscitation. Clinical skills are needed to recognise when a patent is dying, as well as skills in communicating with patients and relatives when that is the case.’
Reaction to the report
Chair of the Future Hospital Commission Sir Michael Rawlins said:
“This report has major implications for the clinical practice of physicians, the training of future generations of physicians, for research and – most importantly of all – for patients. Its implementation will be a challenge for us all – but implement it we must.”
Alzheimer’s Society chief executive Jeremy Hughes said:
“We expect hospitals to be a place of safety and treatment but for people with dementia the reality is that a hospital can be a frightening and stressful place to be, with patients being moved from pillar to post and care too often disjointed. We need nothing less than a revolution in hospitals in order to ensure our NHS is fit for the future.”
Jonathan Ellis, director of policy and advocacy at Help the Hospices, added:
“Improving hospital care is critical, especially for people approaching the end of life. Despite the fact that it is the least preferred place of care at the end of life, it is where most people will be cared for.
He continued:
“Delivering integrated and compassionate care is vital, and hospices have a great deal to offer hospitals in helping to achieve this.”
Future Hospital: Caring for medical patients, which includes 50 recommendations in total and examples of best practice in England, can be accessed from Royal College of Physicians website.
About the Future Hospital Commission
The independent Future Hospital Commission was established by the Royal College of Physicians in March 2012 to find solutions to the current challenges facing the NHS – a rising tide of acute admissions, the increasing number of patients who are frail, old, or who have dementia, patients with increasingly complex illnesses, systemic failures of care, poor patient experience, and a medical workforce crisis.
The Commission brought together patients and medical and healthcare experts to develop a vision for the Future Hospital covering both how patients should be cared for, and the changes in organisation and staffing that would support this vision.
For further information, visit the Royal College of Physicians website.
Leave a Reply