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Introduction to the project
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Last modified date:20 August 2007
The project was concerned principally with acute hospital services, within the context of broader health and social care systems and the move to more integrated patterns of care. The main focus was on the configuration of hospitals and on the process of handling changes to configurations.
These pages are intended to:
- explain the background to the project on configuring hospitals in health and social care systems;
- provide a route in for organisations seeking further information or support relating to reconfigurations.
They will be of most use to:
primary care trusts, acute sector NHS trusts, strategic health authorities, other health organisations and local authorities who are currently considering the configuration of hospital services.
How the work has developed
The Configuring Hospitals project had two strands:
- development of guidance on service change:
"Keeping the NHS Local - A New Direction of Travel"
- supporting NHS organisations and local authorities in dealing with controversial reconfigurations, and developing skills to improve handling of reconfiguration proposals at local level.
The Configuring Hospitals Project has now come to an end but there is very limited support available from the MA. The person to contact is Chris Howgrave-Graham.
The "Hospital at Night"
model has also been developed for out-of-hours care. This model proposes that the way to achieve effective out-of-hours care is to have one or more multi-disciplinary teams working in the hospital out of hours, who between them have the full range of skills and competencies to meet patients' immediate needs. This has been found to be particularly effiective as part of a strategy for achieving compliance with EWTD requirements for junior doctors.
Guidance
On 14 February 2003 "Keeping the NHS Local - A New Direction of Travel"
. was published.
This document sets out new guidance for the NHS on service change. It will help the local NHS to work in a new stronger partnership with the public and staff to find high quality, sustainable solutions for local services, and deliver the agenda for reform. .
Keeping the NHS Local's aim is to help local areas considering reconfiguration of services by:
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outlining an approach to local service design and consultation that reflects both the new requirements for partnership, the
"closer to home"
model of care supported by the National Beds Inquiry and the new opportunities generated by service and workforce modernisation -
it also outlines some of the modernisation strategies available to help provide high quality patient-focused care while ensuring that all staff, including doctors, are supported to work safely without excessive workloads
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the guidance proposes sustainable solutions for smaller hospitals to secure their valued role at the heart of local communities. Service and workforce redesign offer the potential for a wider range of safe, effective, high-quality care to be offered in smaller hospitals that has previously been thought possible.
When considering service expansion and redesign, there are 3 core principles to be followed:
- developing options for change with people, not for them, starting from the patient experience and our commitment to improve choice, and working with staff to develop new ways of delivering services
- focus on redesign not relocate. Redesign can offer a high quality alternative to relocating services, extending the range of options for developing new configurations that meet local needs and expectations
- taking a whole systems view: the NHS needs to exploit the contributions of different hospitals, primary, intermediate and social care providers within a whole systems approach. These providers can expand the range of options available to meet centralising pressures by working in partnership, with genuine integration and joint planning of services.
"Keeping the NHS Local - A New Direction of Travel"
proposes that by exploiting redesign and whole system approaches, models of care can be developed that enable a wider range of services to be sustained in smaller hospitals than traditional models of care would support. The ideas are equally applicable to any hospital considering configuration change, and are closely linked with the implementation of the European Working Time Directive.
Consultation
Keeping the NHS Local also describes some service models, which were for consultation, to promote further discussion and debate. They were not intended to be a restricted menu of options - but illustrations of the kind of innovative, locally-tailored models that can be developed by following the core reconfiguration principles. The consultation period ended on 13 May 2003. The responses received were varied in their emphasis, though all supported the concept of greater patient and public involvement in the planning and development of local health services. Concern was also raised about the availability of the skilled workforce required to adopt the service models suggested.
Supporting evidence and further examples
An Evidence File has also been developed that summarises the published literature on the service models which underpin the Keeping the NHS Local approach. It also lists a range of examples of good practice from the NHS and elsewhere.
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