Hospital Pharmacist
Vol 10 No 3 p92
March 2003

News summary

New Department of Health guidance gives support to smaller local hospitals

New guidance issued by the Department of Health aims to change the way smaller hospitals work for local communities.

The DoH says that the guidance, "Keeping the NHS local: A new direction of travel", challenges the mindset that "biggest is best". It says that new resources and new models of care show that small can work and there is a potential for a wider range of safe, effective, high quality care to be offered in smaller hospitals than previously thought possible.

The guidance makes it clear that technological developments, such as new equipment and new information technology, alongside changing workforce roles, open up a new range of possibilities for smaller hospitals and localised services. The possibilities include:

• Providing increasingly sophisticated day surgery

• Exploring networking between small and large hospitals

• Exploring new ways of providing hospital services at night

The guidance outlines some of the ways local hospitals can be helped to provide patient-focused care while ensuring staff are supported to work safely without excessive workloads. The DoH says that there are three core principles that the NHS will need to follow when considering proposals for change in local hospitals and other services. The core principles are:

• Developing options for change with local people

• Focusing on redesign and not relocation

• Taking a whole systems approach developed across health and social care communities rather than an individual hospital site, trust or organisation

The document provides examples for new models of sustaining smaller hospitals. These include:

• Providing emergency medical and surgical care. One option is to provide 24-hour emergency access to medical and surgical care by using the available trainee and career grade doctors and consultant medical staff more effectively

• Providing local emergency care. A proposed model of care is for patients to receive rapid assessment in a local hospital, with doctors from the nearest larger acute hospital site advising remotely via a telemedicine link. Following assessment, those patients requiring more intensive acute care would be transferred to the larger hospital for direct admission to wards, avoiding the need for a further wait in accident and emergency

Commenting on the new guidance, Health Secretary Alan Milburn said: "Patients want more, not fewer, local services. Changing local health services does not necessarily mean centralising services with fewer, larger 'super hospitals'. This document shows how modernisation and improving the quality of care are about working with local communities and staff to build services around patients' needs."

The document is available as a PDF (260K)

See also Configuring hospitals in health and social care systems