Market forces won’t produce needed restructure, warns King’s Fund
pharmafile | March 4, 2011 | News story | | GP consortia, Health and Social Care Bill, Kings Fund, NHS, NHS Commissioning Board, NHS reforms, foundation trusts, hospital trusts, king's fund
Greater competition in the NHS is unlikely to bring about the restructuring needed in hospital services, according to The King’s Fund.
The health think tank’s new report, Reconfiguring hospital services: lessons from South East London, includes recommendations for policy-makers to ensure that so-called ‘reconfigurations’ of hospital services improve the quality of care for patients.
The King’s Fund closely analysed what it calls the “protracted efforts to reorganise services” in South East London, which it says resulted in four out of the six local hospitals being ‘plagued’ by financial problems and concerns about patient care.
The report warns that major changes to hospital services are both urgent and essential, with services for cancer, cardiology and stroke requiring consolidation around specialist centres. This will mean the closure of local services, which frequently proves a very unpopular policy.
The King’s Fund says the experience shows that relying on market forces alone will not deliver the changes needed, with the risk that the quality of patient care will deteriorate in hospitals faced with large financial deficits.
Instead, it says strong, strategic commissioning is needed to reconfigure service. The think tanks says government’s health reforms will not help this process, particularly as the current the strategic health authorities are to be abolished. The report concludes that GP consortia “are unlikely to be able to fulfil” the SHA’s former role.
The report recommends that future hospital reconfigurations are based on ‘best practice’ models of care, with specialist services concentrated in centres of excellence and other sites providing more routine care and rehabilitation, rather than all the hospitals in a local area providing a full range of services. While this would require major changes to the way hospitals are organised, including the closure of some facilities, evidence shows that these ‘networks’ of care improve outcomes for patients and are more cost effective.
The recommendations in the report include:
• Amending the Health and Social Care Bill to ensure that the new NHS Commissioning Board is able to oversee changes needed in the best interests of patient
• Changing the way hospitals are funded to help those struggling to manage large debts as a result of PFI contracts
• Supporting the acquisition of hospitals with large financial deficits by high-performing foundation trusts.
The report’s author, Keith Palmer, said: “With the NHS facing an unprecedented financial challenge, major changes to the way hospital services are provided are essential. Relying on market forces alone will not deliver the changes needed, with the risk that patient care will suffer. It is vital that the Health Bill currently before parliament provides the right levers to drive the changes needed.”
The report is published ahead of a number of decisions on hospital reconfigurations expected in the coming months. Shortly after the coalition government came to power, it called a halt to all planned reconfigurations and then announced four key tests against which they should be assessed.
The requirement for all hospital trusts to achieve foundation trust status by 2014 is another key factor behind the need for reconfiguration.
Andrew McConaghie
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