Future Hospital Commission – a patient-centred model

Care must come to the patient, rather than the patient being moved around their hospital for different treatment – that is the major recommendation of the Future Hospital Commission (FHC).

Set up by the Royal College of Physicians (RCP) in 2012, the FHC has been investigating how acute medical care can be redesigned to prioritise the patient experience. The report, ‘Future Hospital: Caring for medical patients’, calls for acute wards and management teams to be restructured to better manage increasing numbers of frail patients, or those with complex illnesses.

The report highlights that patient experience should be as important as clinical outcomes, and recommends locally determined ‘citizenship charters’ to ensure staff provide care with dignity and respect for patients.

Patients should be fully involved in decisions about their care and planning for care after hospital should begin on admission, the FHC said. Other recommendations include access to the same care at weekends as during the week, and for continuity of care to be the norm.

The development of a ‘clinical coordination centre’ could help hospitals to control real-time patient information and enhance communication. New roles; a chief of medicine and chief resident would help to increase accountability and improve liaison with junior doctors.

Sir Michael Rawlins, chair of the FHC, 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.”

Professor Tim Evans, lead fellow for FHC said the report could provide a unified template which could be adapted to the needs of different patients.

Sir Richard Thompson, president of the RCP, called it “a once in a generation opportunity…to develop a vision of the future hospital, a hospital which is no longer bound by its walls, but reaches out into the community to care for medical patients”.

He confirmed that the RCP would take forward the 50 recommendations in the report and look for opportunities to pilot these in trusts.

Dr Peter Carter, chief executive & general secretary of the Royal College of Nursing said: “The Commission rightly focuses on a patient-centred approach to care, and the smooth and safe transfer of patients from hospitals to the community.”

Michelle Mitchell, director general at Age UK, welcomed the recognition that sometimes older people needed care in hospitals to deal with complex needs. She said: “There is a need for real action now to ensure all hospital staff are well trained in caring for frail older people and empowered to deliver excellent care.”

Dr Chris Roseveare, SAM president and member of the steering group for the Future Hospital Commission said: “Acute Medical Units are an integral part of the solution but we must also ensure that high quality, co-ordinated care is provided for patients throughout their hospital stay and following discharge from hospital.

“Turning this into reality will require clinicians to work closely with their managers, patients groups and commissioners over the coming months and years so we can ensure that the ‘hospital of the future’ becomes the ‘hospital of the present’”.

Chief executive of the NHS Confederation Mike Farrar welcomed the emphasis on care delivery according to patient needs, and greater local decision making, while Dr Mark Newbold, chair of the NHS Confederation's Hospitals Forum, said the report “provides authoritative guidance on the future development of these vital services”.

Candace Imison, acting director of policy at The King’s Fund, said the report “puts the needs of the patient centre stage” and, if implemented, the recommendations could provide a step change in quality of care.

She added: “It throws down the gauntlet to other professional bodies to provide equally imaginative and patient centred solutions to the problems we face in providing care to our ageing population.

“It also challenges the notion that the only solutions to the problems faced by many hospitals are merger or hospital closure and provides ideas and opportunities to sustain more services locally. Hospital Boards and senior doctors need to demonstrate their commitment to transforming patient care by making this vision a reality.”

Dr Cliff Mann, president of the College of Emergency Medicine said: “The implementation of this report will be a challenge – but we agree that it must be addressed. Unifying and integrating the hospital and wider healthcare facilities, including those related to primary and social care will benefit the care for our present and future patients.”

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