• Splitting urgent and planned work onto different sites drives improvement, says long-term plan
  • Plan adds: “We will continue to back hospitals that wish to pursue this model”
  • NHS will also develop new “standard delivery model” for smaller hospitals, says plan

NHS bosses will encourage more hospitals to separate urgent and planned services onto “hot” and “cold” sites, according to the NHS long-term plan

The plan, published earlier this week, said splitting services in this way – a strategy already being perused by several hospital trusts – makes it easier for NHS hospitals to run efficient surgical services.

It added: “We will continue to back hospitals that wish to pursue this model”.

The document noted providing planned services from a “cold” site guards against the capacity being taken up by emergency admissions, reducing the risk of last minute cancellations.

Meanwhile, managing complex, urgent care on a separate “hot” site allows “improved trauma assessment and better access to specialist care, so that patients have better access to the right expertise at the right time”.

Gloucestershire Hospitals Foundation Trust was cited as an example of a provider which has successfully reconfigured services in this way after facing significant challenges, with poor accident and emergency performance, and high numbers of cancellations and delays to planned operations.

The national Getting it Right First Time efficiency programme supported the trust in splitting its ‘hot’ emergency work and ‘cold’ planned trauma and orthopaedics work onto two separate sites.

The report said: “Senior clinical decision makers were introduced at the A&E ‘front door’ to help ensure patients were managed more effectively.

“During the first six months the trust was able to achieve its four hour A&E target for the first time since 2010 and had halved the number of cancelled operations. There was a reduction in waiting times for surgeries, including for hip or knee replacements, and an 8 per cent increase in the amount of elective surgery performed.”

System leaders acknowledged such a split would not be feasible in some areas. It said it would “introduce a new option of ‘A&E locals’” for these areas.

HSJ has asked for further details on the “A&E local” model, but NHS England had not responded at the time of publication.

The plan also said it will develop a new “standard model of delivery” for smaller hospitals in rural areas.

The plan said: “Smaller hospitals have significant challenges around a number of areas including workforce and many of the national standards and policies were not appropriately tailored to meet their needs.

“We will work with trusts to develop a new operating model for these sorts of organisations, and how they work more effectively with other parts of the local healthcare system.”

The recommendation follows a major NHS England-commissioned Nuffield Trust study, shared with HSJ in October last year, which set out core principles for redesigning smaller hospitals, although it did not advocate a single model.

Among the report’s recommendations were proposals for a financial premium for remote hospitals, consultant contract changes and ending the practice of separating out services like ambulatory care.

Nuffield Trust chief executive Nigel Edwards told HSJ he welcomed the acknowledgement of the need to address the sustainability of smaller hospitals. But he warned that “while you could specify a standard model, it would take a long time for a lot of trusts to work towards it”.

“The ability for these hospitals to migrate to a standard model would be constrained because they all have very different models as starting points. But it would be helpful to have some design principles to develop some different ways to deliver services,” he added.