Caring for medical patients Future Hospital: Caring for medical patients Presentation for clinicians

Context and development

Why establish the Commission? ‘I was moved five times, all done at night time, some of them with nurses wheeling me down corridors with all the contents of my cabinet on my knee. It is very impersonal. You feel like a package.’ RCP Patient and Carer Network member

Why establish the Commission? ‘My trust does not function well at night and I am relieved on Monday that nothing catastrophic has happened over the weekend’ Hospital doctor’ Hospital consultant Taken from RCP membership survey 2012

Why establish the Commission? ‘We need to take responsibility for every patient who comes through the hospital door. Consultants need to reclaim responsibility for all aspects of medical care, whatever their speciality.’ Hospital consultant

Why establish the Commission? Hospitals on the edge? Rising clinical demands Changing needs Fragmented care Out-of-hours care breakdown Medical workforce crisis rising clinical demands (37% rise in emergency admissions, fewer beds) changing needs (more older people, with multiple, complex conditions) fragmented care (patients being moved around the system with little continuity) out-of-hours care breakdown (higher mortality at weekends and fewer senior staff) medical workforce crisis (increased workload, recruitment problems in emergency and general medicine)

Time to reflect Do you know how often your patients are moved in the middle of the night? Do you know how often the same patient is moved – not necessarily at night? How often does a patient have to repeat his or her personal information and medical history? Is the language used in your organisation appropriate? Are you satisfied that there is enough senior decision making at the front door?

Future Hospital Commission Establishing the Future Hospital Commission

Constitution of the Commission Patients Managers Social care Nursing Physicians GPs Anaesthetists Surgeons Trainees Health academics Public health and others Patients involved at every step Mike Farrar, NHS Confed Jennifer Dixon, Nuffield Trust, now Health Foundation David Haslam, NICE Duncan Selbie, Public Health England Andrea Sutcliffe, Social Care Institute for Excellence, now chief inspector of social care

What does the report cover? Organisation of medical care and teams Education, training and deployment of medical staff Building a culture of compassion and respect Management, economics and leadership Information systems Organisation of medical care and teams (from the emergency department, to wards and into the community) Education, training and deployment of medical staff (medical staff with the skills and expertise to meet the needs of patients) Building a culture of compassion and respect (that values patient experience and support staff to deliver compassionate care) Management, economics and leadership (rebalancing finances to give priority to acute and complex care; promoting clinical leadership) Information systems (That facilitate patient-centred care across settings and support improvement)

Recommendations

New principles of acre Eleven principles of patient care, including: Patient experience valued as much as clinical effectiveness Clear responsibility for each patient’s care No wards moves unless necessary for clinical care Robust arrangements for transferring of care Self-care and health promotion facilitated. Care plans that reflects individual needs for all

A new model of hospital care Medical Division Acute Care Hub Clinical Coordination Centre Medical Division Covers all medical services and teams Remit from hospital into community Led by Chief of Medicine Acute Care Hub Part of Medical Division Covers assessment and initial management of acutely ill patients (focus: first 48 hours) Overseen by acute care coordinator Clinical Coordination Centre Operational control centre for medical services All data on patients – needs and real time monitoring All data on capacity and resources

Care where patients need it Clinical leadership for safety, outcomes and experience Medical care coordinated by single consultant Specialist medical teams work: - across wards - at the ‘front door’ - into the community To deliver: early assessment by senior doctor ‘fast-tracking’ to specialist wards ‘same day’ emergency care early care planning

Care across seven days Consultant presence on wards over seven days Team rotas designed over seven days Arrangements for leaving hospital across seven days

Education, training and deployment Internal medicine valued and promoted More participation in (general) internal medicine Training in internal medicine across specialties Structured training for internal medicine Clinical workloads regularly reviewed Non-elective medical care prioritised in: - job plans - financial structures

Information supporting care Patient-focused clinical records Single electronic patient record Common record standards Viewable in hospital and community

Reaction and next steps

Reaction ‘Most important statement about the future of British medicine for a generation’ ‘the result could be a step change in the quality of care’ Summary of launch activity 11 September: press conference 12 September: Launch Face to face briefings Party conferences Speaking engagements 27 November: Parliamentary event ‘Doctors propose cure for failures on wards’ Welcome to the hospital of the future ‘…bold and refreshing’

Impact Heart of England Foundation Trust has already advertised for a Chief of Medicine

Realising the Future Hospital RCP Future Hospital Programme (2014-2017) improve care for patients develop and implement vision - medical care in hospital and community drive real change - recommendation to reality work in partnership with: - patients - individual hospitals and teams partners across health and social care (FH strategic advisory group) national stakeholders RCP Exec Board and implementation group: Has been established and will oversee ongoing work Partner sites: Hospitals evaluating recommendations and establishish how the model can be implemented Consultation: Explore impact of recommendations (eg with specialist societies), looking at: impact on education and training interaction of specialist teams link with existing work (eg good practice; 7-day & reconfiguration projects) Identify levers in new structures: Identify key stakeholders and levers (eg new health service structures in England). Develop tools to communicate and implement FHC recommendations (eg with NHS workforce, public and policy makers) Sharing good practice: The RCP is establishing a Future Hospital Journal to assess. Review and share good practice Embed in existing work: Use RCP committees and network to promote messages of FHC (eg ‘Future hospital champions’)

Realising the Future Hospital Consult Future Hospital partner sites develop model understand implications identify barriers and changes promote and mentor Promote good practice - Future Hospital Journal Influence - identify levers in new structures Embed in existing RCP work RCP Exec Board and implementation group: Has been established and will oversee ongoing work Partner sites: Hospitals evaluating recommendations and establishish how the model can be implemented Consultation: Explore impact of recommendations (eg with specialist societies), looking at: impact on education and training interaction of specialist teams link with existing work (eg good practice; 7-day & reconfiguration projects) Identify levers in new structures: Identify key stakeholders and levers (eg new health service structures in England). Develop tools to communicate and implement FHC recommendations (eg with NHS workforce, public and policy makers) Sharing good practice: The RCP is establishing a Future Hospital Journal to assess. Review and share good practice Embed in existing work: Use RCP committees and network to promote messages of FHC (eg ‘Future hospital champions’)

Questions? www.rcplondon.ac.uk/futurehospital futurehospital@rcplondon.ac.uk