NHS Confederation: Hospital-based care 'must change'


Andrew Lansley: "It's not about moving people out of hospitals, it's about giving them the best possible care"

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The NHS in England must end the "hospital-or-bust" attitude to medical care, says the body representing health service trusts.

At least one in four patients would be better off being treated by NHS staff at home, figures suggest.

2012 will be a key year for the NHS as it tries to make £20bn in efficiency savings by 2015, according to the head of the NHS Confederation, Mike Farrar.

Ministers say modernising the NHS will safeguard its future.

Mr Farrar said: "Hospitals play a vital role but we do rely on them for some services which could be provided elsewhere.

"We should be concentrating on reducing hospital stays where this is right for patients, shifting resources into community services, raising standards of general practice, and promoting early intervention and self-care.

Start Quote

The old hospital-based system has to develop into a more preventative, community-based system”

End Quote Steve Field NHS Future Forum

"There is a value-for-money argument for doing this, but it is not just about money and the public need to be told that - this is about building an NHS for the future."

Mr Farrar said the required changes included treating frail people in their homes, and minimising hospital stays wherever possible.

Politicians and NHS leaders must show the public how these changes could improve care, rather than focusing on fears over the closure of hospital services, he added.

"Many of our hospitals know that the patients that they are treating in their beds on any given day could be treated better - with better outcomes for them and their families - if they were treated outside of hospitals in community or primary care," he told BBC Radio 4's Today programme.

'Place of default'

Mr Farrar told Today that people had become used to "the hospital being a place of default" and that primary and community healthcare services had sometimes been under-funded.

Mike Farrar, NHS Confederation: "It's much better for a good number of patients to be cared for in their homes"

But he said even where clinicians knew that better care could be provided outside of hospitals, and politicians accepted this privately, the public debate had not helped individuals understand that.

"We need the politicians and the clinicians to stand together with one voice to explain these changes," he said.

"I think the time has come for real political courage on all parties to stand up and say 'if the evidence is clear that my constituents will get better outcomes because they travel a bit further' or indeed that 'if we can release the costs of these beds to make services available in your own homes' - then that's the right thing to do."

Commenting on the new year message from the NHS Confederation, Health Minister Simon Burns said in a statement: "Modernising the NHS will both safeguard the future of our health service, and will deliver a world-class service that puts patients at the heart of everything it does."

The chair of the independent NHS Future Forum, Steve Field, said: "The old hospital-based system has to develop into a more preventative, community-based system."

And shadow health minister Liz Kendall added there would be "difficult decisions" that had to made.

"The NHS Confederation is right to say this will require real leadership from the NHS and politicians."

But she questioned whether the government would be able to provide this as it was embarking on a major reorganisation of NHS structures.


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  • rate this

    Comment number 563.

    I think the NHS is wonderful, but it is really inefficient and has huge amounts of waste, if a private sector company had the same level of waste it would go bust.

    We also need to charge foreign national for using the NHS even if it is an emergency, or add a £20 insurance fee upon entering the UK. You get charged a$ 50USD development fee when leaving barbados

  • rate this

    Comment number 562.

    "537.Suffolk Owl

    A good idea would be to setup A&E clinics in local areas where walk in injuries can be dealt with promptly and any injury needing further attention can then be forwarded to the main A&E departments in time."

    Already done under the last government, using the 'brand' of Walk In Centres. It works very well.

  • rate this

    Comment number 561.

    Perhaps its time to resurrect the cottage hospital? Not everyone has family to care for them and there just are not enough community nurses to provide good care at home. The cottage hospital provided nursing care, especially for the chronic sick, in the local community, run by GPs, and freed up the major hospitals for the more seriously ill.

  • rate this

    Comment number 560.

    To: nieuw divil

    Does the fact that 9 out of the 20 comments on the lowest rated page are yours (including the top 2) not make you realise that many people disagree with your rants.

    I had an experience of being a patient in a private hospital (through a work related health policy). The surgeon made a mistake during a standard operation and I had to go to an NHS hospital to have it put right!

  • rate this

    Comment number 559.

    I say again, the UK must follow the US model, which provides effective, affordable healthcare for those who deserve it.

    The principal that one should take responsiblity for one's life is an anathema to the left who believe that a hard working minority should be forced to subsidise an indolent majority but that model (which spawned NHS) is unsustainable.

  • rate this

    Comment number 558.

    "poorly trained practice/home nurses" "My experience of it is that it's just incompetent"

    you will miss it when it goes
    its the users of the NHS that are incompetent and uneducated
    The NHS is a great service it is just misused by ignorant malingerers that take no responsibility for themselves stop calling ambulances for petty things,stop turning up at A&E drunk,take your bed blocking elderly home

  • rate this

    Comment number 557.

    541. Ex Tory Voter:
    Thanx for that. Do you earn 60k after tax. I don't. Nor do I have 24K that I will soon need to find. The funding is a real issue. Being a carer would be an option if I could deal with a man with a missing leg and a brain injury dementia and a woman with Alzheimers who operates around the clock. How much sleep could you do without over the next 10 years? I am disabled.Think!!

  • rate this

    Comment number 556.

    Now everyone agrees that lots of patients can be treated in day units,or others have been in hospital waiting on home care being set up.
    But the goverment do not put funds into this,thats why we have problems.
    But now in England,soon to be spread into the rest of the UK are going private,will hospitals want to kick out private patients and clear up beds,while they are making money,of course not.

  • rate this

    Comment number 555.

    On july 4th this year because of hospital incompetence, which has since been recorded by those in hospital and sent in print to me, my mother suffering with incurable cancer "suffered in agony" for up to five-hrs before administration of a syringe-driver was administered. Can you imagine the destruction to my heart and soul? The NHS needsmoney

  • rate this

    Comment number 554.

    Comments so far look like - we're panicky. Mr Farrar (NHS Confederation site) implies reassurance is: be honest about issues, bold about solutions, decisive in action.
    My translation: The change is complex, risky. A patient at home needs quality care which costs money. So the NHS must actively integrate services, lose hospitals, lose jobs - anything to make the change and so protect patients Yes?

  • rate this

    Comment number 553.

    534 Steve

    No one is claiming its perfect. But like many people I object to people extrapolating from an example of one that the system is hopeless. Of course in a system as big as the NHS there will be some failures ... but one person on here with an example of poor care for their Mum doesn't mean an overall poor service.

  • rate this

    Comment number 552.

    How will the government save £20 billion by 2015?

    Stop the PFI rip-off

    "Treasury figures show that taxpayers will spend £229 billion on projects that cost the contractor only £56 billion."

    There that's £173 billion.

  • rate this

    Comment number 551.

    And this on the back of he NHS to hand over 49% of its capacity to the private sector.
    Do we want strangers in our homes when we are most vulnerable? They will have no back up and no one to supervise them.
    Also, I am sure there are many homes that are just not sanitary enough for someone that has had surgery amongst many other considerations.

  • rate this

    Comment number 550.

    506. Maureen Gobener

    'What on earth is going on when we read that there's a shortage of GPs. Is it that young men and women no longer wish to pursue a worthwhile career, or is it that funding is being withheld?'

    Top universities chocca with foreign med students

    After all unis been told for along time to be businesses

    UK medics very welcome abroad so some go

    What would you do

  • rate this

    Comment number 549.

    To those bashing the NHS. I have Crohn's disease, and have had 7 major operations and 11 admissions, due to serious complications caused by Crohns, over 20yrs. That's good compared to others. Even now I feel guilty about making a GP appointment.

    Our highly trained NHS staff saved my life, many times over, and enabled me to keep working and paying tax toward the NHS for future care.

  • rate this

    Comment number 548.

    and again. Just in case you think this hypothetical, it is true. The current system relies upon panels to means test and perhaps pay Continuing Healthcare Funding. These proposals are an extension of what is seen to be a success. Explain how mum got CHC for a year and has now become well and so has no need of funding. She is dying slowly from ALZHEIMERS. What chance have you got to be funded.

  • rate this

    Comment number 547.

    Care in the community? Where have I heard that before? Oh yes, the 1980's along with all of this govts ideas. This was a bad idea then, driven by an urge to cut costs more than provide real care, and it's a bad idea now.

  • rate this

    Comment number 546.

    What on earth is wrong with profit? Nothing! It encourages efficiency, modernisation and good practise!!!

    What is wrong with state enterprise? Everything! Inefficient, corrupt and incompetent.

    The NHS is a huge dead weight dragging the UK economy under. It must be removed now, before the country implodes!

  • rate this

    Comment number 545.

    Yes it would be better if more people could be treated at home, However we need to be aware that choices we make in early retirment may make this difficult.. At this time we need to be nearer our children and living in a bungerlow or flat. People in later life find it very hard to make these decisions and to often find themselves isolated too far from family help and unable to cope with stairs.

  • rate this

    Comment number 544.

    There are many problems in the NHS, but what is not going to help is the lobbyist-driven major privatisation through the Health and Social Care Bill. We will create a far more unequal, two-tier service. And it won't be any cheaper. For all its many problems, the NHS performs a lot better and more cost-effectively that most others countries' systems.


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