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

2. Context and development

3. 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

4. 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

5. 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

6. 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)

7. 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?

8. Future Hospital Commission
Establishing the
Future Hospital Commission

9. 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

10. 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)

11. Recommendations

12. 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

13. 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

14. 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

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

16. 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

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

18. Reaction and next steps

19. 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’

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

21. Realising the Future Hospital
RCP Future Hospital Programme ( )
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’)

22. 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’)

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