Service redesign key to survival of local hospitals

An NHS Confederation report Local Hospitals: lessons for the NHS uses Central Middlesex Hospital as a case study of how district general hospitals confronted with the loss of key services can remain viable.

The trust has significantly redesigned how it provides care over the past 15 years. The hospital has shed 400 beds but in several areas activity has increased or remained stable. It has separated its services into two separate units, one dealing with most elective work and one in Brent handling emergency, acute and chronic patients and major elective work.

There has been a large degree of service redesign and the eventual aim is for the Brent centre to create a single service for patients with chronic diseases, merging primary and secondary care.

Confederation policy director Nigel Edwards told HSJ the report looked at how you "avoid the domino effect of the whole thing exploding when you lose one or two key specialist services".

"The really big thing for me is how pathway design is transferred into staffing and buildings."

Perverse incentives

The report, by North West London Hospitals trust directors John Riordan, Sir Graham Morgan and David Powell, with former HSJ editor Peter Davies, acknowledges that plans can be hindered to some extent by "perverse organisational incentives".

Mr Edwards said: "The payment by results regime doesn't give you an easy way of rewarding [changes] when you keep people out of hospital."

He said the emerging integrated care organisation models, pilots of which are being selected by the Department of Health, could offer new ways of achieving the change.

The confederation hopes the report will prompt further discussion about local hospitals. Mr Edwards said: "The question I am asking is, 'What does the rural variation look like?'"

HSJ's Delivering NHS Quality Improvement conference is in Birmingham on 31 March.