Is Simon Stevens appropriate to back local community hospitals?

There will not be a return to an era exactly where hospitals were staffed by matrons who ruled with a rod of iron, writes Malcolm Prowle. Photograph: George Freston/Getty Photographs

In a current interview, Simon Stevens, the head of the NHS in England, appeared to mark a change in policy by calling for a shift away from large centralised hospitals and in the direction of community hospitals with new models of care created all around smaller local hospitals. In some methods this sounds radical but closer examination may suggest that it is just a phase on an evolutionary pathway.

For 60 many years, the bedrock of the NHS was the district standard hospital (DGH), which delivered a variety of hospital companies, other than specialised tertiary providers at university hospitals, to a regional population of possibly half a million folks. However, in recent many years this procedure has started to change with a far more varied pattern of providers developing, incorporating DGHs specialising in particular facets of healthcare, expanded major care centres, walk in centres and community hospitals.

Community hospitals are properly positioned to help patients on their complicated journeys of care through the health and care technique. They can be noticed as a nearby hub for a variety of easily accessible wellness providers and may well also offer signposting to other solutions such as individuals provided locally by the third sector. Community teams can also assist to prevent emergency admissions to acute hospitals and can play a significant role in supporting the reduction of hospital delayed discharges.

Nonetheless, this does not imply a return to an era where hospitals had been often staffed by matrons who ruled with a rod of iron and exactly where general practitioners popped in to do a bit of schedule surgery. Neither does it indicate that many existing, and a lot loved, community-based hospitals will not be closed the place they are identified to be obsolescent, inappropriate or just plain outmoded. This will undoubtedly make a great deal of local opposition but, personally, I have observed scenarios in which the public opposed the closure of a hospital which was not just unsuitable but unsafe.

However, new local community hospitals will carry on to be built. All through the nation it is possible to discover examples of exactly where an outdated community hospital has been closed and replaced, a few years later, by a new one particular nearby.

Complicated health care and surgical care will nonetheless be offered at large hospitals, in which doctors can specialise in particular elements of medicine and can have better clinical outcomes than in hospitals the place no such specialisation requires location. Nevertheless, other services this kind of as care of older folks, lengthy-term care and patient rehabilitation may be far better undertaken in the significantly calmer atmosphere of a community hospital. In some instances, diagnostic and some therapy actions for acute patients may well also be presented at a spot far more hassle-free to the patient.

Some will argue that smaller community hospitals are inherently significantly less productive due to the fact of their dimension but this might not be the situation. Usually larger organisations (this kind of as a DGH) can have inefficiencies that are identified in several largeish bureaucracies and tiny hospitals can have higher scale and flexibility. It is, consequently, a debateable point as to whether local community hospitals will cost more to run and will need added funding.

There will be strong barriers to the notion of more local community hospitals. Not all healthcare experts will be pleased to operate in such units and could see them as boring considering that they are not functioning at the cutting edge of healthcare. Consequently, they might see this as a block to their individual profession prospective customers.

Several individuals, including myself, will look on neighborhood hospitals favourably as a area for elderly family members to invest the final years of their lifestyle. The calmer setting and the higher degree of familiarity with nursing and other staff will be a welcome alter from the hustle and bustle of the huge hospital.

A single may wonder why Simon Stevens has selected this controversial topic to mark one particular of his earliest interviews as head of the NHS. Could it be that community hospitals are extremely popular with the public and that this will generate good news for the NHS even however, as currently observed, the variety of local community hospital being proposed is very various from that of the romantic past? Alternatively, is it just a signifies of distancing himself from the previous NHS regime by a substantial change in policy? Time will tell how far the configuration of the NHS will alter as a consequence.

Malcolm Prowle is professor of business efficiency and co-director of the Wellness and Social Care Finance Study Unit at Nottingham Business School

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Is Simon Stevens appropriate to back local community hospitals?