My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

Read my statement in full »

The hospital is dead, long live the hospital: Sustainable English NHS hospitals in the modern world

Filed Under (Health and Social Care Bill, Health Improvement, Hospitals, Reform of the NHS) by Paul on 15-09-2011

Today, September 15th, we are publishing, through the think tank Reform, a pamphlet about the necessity to convert the work of NHS hospitals into a much more sustainable set of business models. These changes will be difficult for both those inside the NHS and for those outside. However not facing up to the need for these changes will build into the NHS much greater inefficiencies, and outcomes that fail to reach the level of safety that we have come to expect.

The financial pressure facing the NHS is unprecedented. Over the course of this Parliament the health service must deliver £20 billion of efficiency savings. With 50 per cent of the health budget spent in hospitals, NHS hospital trusts are in the front line in the drive to achieve more for less.

Cutting costs in hospital services means that services need to be transformed, with fewer beds, smaller wards and in some instances complete conversions of the way in which hospitals work. The financial pressures on hospitals are not a short term problem. Some hospitals have been facing difficulties for years, often associated with the delivery of poor quality care, and a growing number will become financially unviable.

Over the course of this Parliament as many as 40 hospitals may have to change radically or close. Currently, hospital failure is averted by granting a variety of forms of interim financial support, yet if the Government is to continue to protect all of England’s hospitals from closure or reconfiguration then this “inefficient hospital fund” could grow to as much as £8 billion.

This would mean that the Chancellor would have to find an extra £5 billion to bailout the NHS by 2013.

It is not only financial pressures that are causing hospitals to change. Changing health needs and the challenges of managing care for people with long term conditions make it imperative to develop new health services. Alongside hospital turnarounds to ensure affordable high quality healthcare, integrated care services will have to be organised around patients outside the hospital settings. Integrated care demands that more services are delivered in the community and home, harnessing the potential of modern medicine and the latest technologies.

NHS hospitals currently try to be all things to all people and deliver every healthcare service to everyone.

This is no longer clinically or financially sustainable and it holds the NHS back from delivering better, safer and higher quality care. To survive, hospitals need to change their business models. They should become either “solution shops”, which focus on diagnosing patients, or organise treatment efficiently and safely in a “factory” mode of production that delivers “valued added processes” for patients.

To some extent, these modern organisations already exist in the NHS and across the world in emerging economies and more developed countries. But if the NHS is to deliver outcomes that are among the best in the world and remain affordable, all hospitals will have to change the services they offer to patients.

When passed, the Health and Social Care Bill will create more pressures on hospitals to change, through stronger commissioning and extended patient choice. Yet politicians of all parties are still reluctant to support hospital conversion. The Government’s pledge to protect hospitals and create additional barriers to redesigning local services will make it harder for the NHS to deliver £20 billion in savings and maintain quality care.

Key ways in which national policy can support the emergence of better models of healthcare delivery in England include:

  • No bailout for the NHS: the learnt behaviour in the NHS is that the Chancellor will always find more money to avoid the embarrassment of a hospital closure. This weakens the case for change for NHS leaders and confuses the incentives for all in the system. For hospitals to change they cannot believe the Government will bail them out.
  • Better commissioning: commissioners acting on behalf of patients should disinvest in expensive and poor quality acute services and instead invest more resources in primary and community care, forcing incumbent hospitals to change the services they provide or go out of business.
  • Intensify market pressures: greater patient choice and new providers will create real incentives for NHS hospitals and other service providers to modernise in order to deliver better services at a lower cost.
  • Failure regime: the Government must set out a clear, transparent and enforceable failure regime for hospitals. This will force hospital leaders to change their business models and empower other organisation to intervene and turn around failed institutions.

The hospital is dead, long live the hospital: Sustainable English NHS hospitals in the modern world.

Paul Corrigan CBE; Caroline Mitchell

Published by Reform September 2011


One Response to “The hospital is dead, long live the hospital: Sustainable English NHS hospitals in the modern world”

  1. Reacting to the report: “The Hospital is Dead Long Live the Hospital”, Health minister Simon Burns said: “Few now deny the NHS must change to meet future challenges… But we believe the NHS should be the opposite of a factory-style operation and instead offer patients high quality, tailored care.That is why our plans give freedom and control to doctors and nurses, puts patients at the heart of everything it does, and safeguards the future of our health service.”

    We are advocating that the potential of “factory mode of production” applied to customisation of individual treatments and medical devices has not been considered in the current debate.

    Current clinical practice and use of standardised medical devices/implants is not tailored care, as such devices are not manufactured to fit individual patients.

    Tailored care is therefore not currently delivered in the NHS as standard practice.

    If tailored care is advocated, we advocate the provision of Engineering Assisted Surgery (EAS) within a concept of “Engineered Healthcare”.

    EAS is defined as “the application of industrial and manufacturing technology to the delivery of healthcare”.

    EAS employs tried and tested industrial management concepts and advanced rapid product manufacturing technology to combine “tailored customised care” with “factory mode” production, with a standardisation of Quality and at much lower cost to the Nation.

    Our business model is based on the successful reforms of Industrial Manufacturing in the 1960’s and applied to healthcare.

    EAS not only creates the “solution shop” but also meets the requirements for tailored care.

    EAS has been operational for circa 20 years. The technology needs to be supported and developed as a core service delivery within the NHS.

    EAS focuses on:

    – improved 3-D diagnosis

    – translation of the 3-D plan into the 3-D patient

    – organisation of customised “tailored” treatments efficiently and safely in a “factory” mode production.

    Independent verification confirms that EAS demonstrates “valued added processes” for patients through treatment customisation, with improved quality and at much lower costs per intervention.

    EAS converts Complex surgery into Simple Interventions; e.g. 10+hour operations have been converted in to 90min day-case procedures.

    This is of huge significance to patients, commissioners, providers and Government.

    The EAS model is instrumental in delivering outcomes that are comparatively “free of human error” and are among the best in the world. Treatments are affordable and within an increasingly constrained budget.

    Introduction and assimilation of these concepts as core services in healthcare is fraught with problems, but we argue that introduction of EAS is inevitable in the long term.

    Current NHS culture actively prevents rational change and this adversley affects effective modernisation, to the disadvantage of the tax payer.

    An autonomous multidisciplinary National Engineering Assisted Surgery Centre within the NHS is advocated to define guidelines, the optimum operational infrastructure within a controlled environment.

    We welcome input from interested parties.

Leave a Reply