The RCP welcomes the publication of the King’s Fund briefing paper Reconfiguration of hospital services. Commenting on the report, Sir Richard Thompson, president of the RCP, said:
There is an urgent clinical need to reconfigure acute services primarily to drive up quality, as well as to contain cost. The current system is often lengthy and wasteful. The RCP wants hospitals to provide a consultant delivered service seven days a week. Too often junior doctors care for too many patients out of hours. Reconfiguration of acute services is needed to achieve this improved service for patients.
The RCP agrees that clinical leadership should be strengthened to lead the reconfiguration process. Local clinicians should be at the heart of reconfiguration decisions, as they are best placed to understand the health service needs of their local communities. This was reflected in the government’s amendments to the Health and Social Care Bill dealing with service provider failure, published last week, but we believe responsibility for driving reconfiguration processes forward can still be made clearer.
We also agree that Monitor, the economic regulator, should take account of clinical quality issues when taking action to protect the continuity of services, or assessing whether a trust can change the terms of their license. The government announced last week that CQC and Monitor will have a joined up licensing process, we would like more detail on this soon.
The government correctly wants reconfiguration decisions to involve the local community as their support is necessary. However, local preferences about the location and quantity of services must be balanced against regional and national needs and affordability. It is unclear how this tension will be resolved and we pres the government for clarity.
The government intends that there will be effective safeguards to protect patients’ and taxpayers’ interests by ensuring continued access to essential services should a provider get into financial and/or clinical difficulty. This is welcome, but what are essential services? It is important that the public is fully aware of what services will be protected if a local provider were to fail.