I look forward to working with the new NHS England chief executive to meet the challenge of combining specialist excellence with maximum accessibility
As the Federation of Specialist Hospitals, which I chair, publishes a new report on the outcomes its members achieve, it is great that NHS England chief executive Simon Stevens is reflecting on the ambitions of his predecessor to reduce drastically the number of specialist providers.
The merit of having critical mass in the specialist field has been demonstrated time and time again. But mass can be achieved in different ways.
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In some cases, hospitals may have a range of specialties within a larger unit and deliver good quality results across the board.
In the case of specialist hospitals, we have a declared intention to excel in a particular field.
So, although a hospital such as mine, the Royal National Orthopaedic in Stanmore, north London, will do a lot of the most challenging orthopaedic work, we remain small in absolute terms.
The same can be said for the federation’s other members in areas such as cancer, neurology, ophthalmology and many more.
‘A simple “big is best” approach would have been at risk of being portrayed as crude cost-cutting and run into familiar political headwinds’
The expertise we develop in the process is reflected in the outcomes specialist hospitals achieve. The way in which we share that expertise is critical to the NHS’s ability to meet financial and other challenges it faces.
In particular, we need to make sure we are getting it right first time for people who need specialist treatment, while supporting care close to people’s homes most of the time.
Nor is our expertise limited to the most complex cases.
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Moorfields Eye Hospital, for example, delivers demonstrably better results in routine procedures such as cataracts and glaucoma.
It has taken steps to diffuse that expertise through outreach services so patients do not need to travel to central London to enjoy the superior outcomes that flow from world class excellence.
NHS England’s previously stated intention to reduce the number of specialised providers across all services from 270 to 30 or fewer struck the federation as the kind of well intentioned but doctrinaire approach that has so often come up short.
In particular, it would only have been achievable by concentrating services in a small number of “mega-hubs”, with the almost certain consequence of snuffing out the motivating spirit behind many centres of service-specific excellence.
Furthermore, federation members are notable, not just for their clinical outcomes, but also for their ratings with patients and their families, and typically come at or near the top of the various league tables.
A simple “big is best” approach would have been at risk of being portrayed as crude cost-cutting and thereby run straight into familiar political headwinds.
None of which is to deny the need for a review of specialised providers as part of the five year strategy being developed by NHS England.
In too many cases, patients are being treated in hospitals without the numbers to sustain and develop the requisite levels of clinical expertise. This needs to be addressed but with a guiding clinical rationale and recognition that different solutions may be appropriate in different parts of the country and for different specialties.
‘Combining specialist excellence with maximum accessibility is now achievable in ways that would have been unthinkable only a few years ago’
In the post-Francis report world, there is also a compelling need to ensure the configuration of services meets the approval of the Care Quality Commission.
In this respect, the Royal National Orthopaedic Hospital is hosting a project for the British Orthopaedic Association. Getting It Right First Time involves auditing standards across all the 144 hospitals in England that undertake elective orthopaedic activity.
I would anticipate the recommendation of a significant rationalisation of providers, but the number will exceed NHS England’s original target for all services, let alone orthopaedics.
Furthermore, the project has demonstrated repeatedly that minimum critical volumes for organisations and individuals are often only relevant at procedure – or in some cases body part – level.
The type of rationalisation supported by the initiative will not only improve quality but also reduce complications. This will save huge amounts of money and allow commissioners to purchase services knowing that they are best value.
The federation believes clearly established networks are as an important component in the development of specialised services. These will enable the expertise of specialist hospitals to be nurtured in accordance with their founding principles, while also sharing it efficiently with the wider NHS.
These networks need to be focused not on bricks and mortar but the needs of patients. They need to recognise the opportunities arising, for example, from modern IT as part of high quality care plans. People can then be connected to the best clinical support when they need it, without having to leave their homes or visit the tertiary centre that may, nonetheless, have ultimate responsibility for their care.
So the federation extends a warm welcome to Mr Stevens and looks forward to working with him and colleagues in the NHS to bring fresh thinking to bear on the challenge of combining specialist excellence with maximum accessibility. This is now achievable in ways that would have been unthinkable only a few years ago.
Professor Tim Briggs is chair of the Federation of Specialist Hospitals, and consultant orthopaedic surgeon and director of strategy and external affairs at the Royal National Orthopaedic Hospital Trust