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The Configuring Hospitals Evidence File: Part one

  • Document type:
    Publication
  • Author:
    Department of Health
  • Published date:
    22 July 2004
  • Primary audience:
    Chief Executives,Professionals
  • Product number:
    30102
  • Gateway reference:
    3514
  • Pages:
    39
  • Copyright holder:
    Crown

This is part one of a two part evidence file, which acts as a tool for NHS organisations considering or undertaking service redesign. It includes evidence underpinning the ideas in Keeping the NHS Local from peer-reviewed journals from national and international sources.

Introduction

Keeping the NHS Local sets out new guidance for the NHS on service change. It prescribes the principles and approach that should be applied to all proposals for reconfiguring acute hospitals, with some service models for consultation. This evidence file is first and foremost a tool for NHS organisations considering or undertaking service redesign. It describes how the approaches proposed in Keeping the NHS Local have worked in practice in other health communities. It also describes approaches that have worked less well.

The evidence is organised in two parts:

PART ONE: (this document) includes reports of clinical trials, service audits and reports of service innovation from peer-reviewed medical journals. We have included evidence that may be adverse to the proposals in Keeping the NHS Local. Part One is divided into six sections:

  • Section One - Hospital volumes and outcomes: Recent evidence about the safety of patients in smaller hospitals and the safeguards needed to ensure high quality, safe healthcare at small centres.
  • Section Two - Using telemedicine to support local health services: Studies of the safety and effectiveness of telemedicine to make health services accessible to local communities and to sustain small, rural hospitals and primary care.
  • Section Three - Minor injury units: Evidence about the clinical effectiveness and safety of MIUs and walk-in centres, and reports of how they are staffed and organised.
  • Section Four - Extending the roles of nurses, and allied health professionals: Evidence on the safety of giving nurses and other health professionals responsibilities traditionally assumed by doctors. The section also includes reports on the impact of extending roles on service provision as well as reports on new ways of working in a range of healthcare settings.
  • Section Five - Ambulatory Care: The published evidence on the kind of ambulatory care envisaged in 'Keeping the NHS Local' is very limited, as the concept is a relatively new one. Most of the relevant literature is on walk-in centres. There are difficulties in using international reports on these centres as, unlike their NHS counterparts, Canadian and American walk-in centres are led by GPs with support from nurses and hospital doctors. While there are descriptive reports about health centres offering a wide range of services, (reported on in Part Two of the evidence file) there have been no clinical trials yet completed comparing ambulatory to secondary care.
  • Section Six - Maternity services: Evidence on outcomes at midwife-led units and of the relative performance of midwives and doctors in managing childbirth.

There are also annexes on heart disease and cancer, showing how the national guidance on these areas relates to the issues raised in Keeping the NHS Local.

Part One of the evidence file is drawn from international and national sources and varies in its scientific rigour. It ranges from expert opinion, clinical trials, non-analytical reports, case studies to systematic reviews of research. The criteria for selection and methodology for Part One is set out in Annex One.

Part two and related information

PART TWO of the Evidence File offers examples of service innovation and good practice from the National Health Service that reflect the principles of Keeping the NHS Local and is presented as a separate document.

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