Rationalizing Acute Care Services

119 Pages·2018·8.07 MB·English

by  Pauline Mistry

Rationalizing Acute Care Services
Pauline Mistry
Managing Director
Health Care Division
Oxford International Group
First published 1997 by Radcliffe Publishing
Published 2016 by CRC Press
Taylor & Francis Group
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© 1997 Pauline Mistry
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ISBN-13: 978-1-85775-125-3 (pbk)
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To
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Chancellor Emeritus, Georgetown University Medical Center
For his extensive contributions to health services management.

Contents
Preface Vlll
1 Summary of changes in the NHS over the past decade 1
Introduction 1
The 1990 NHS reforms 2
The allocation of resources 3
The impact of contracting for services 4
The development of competition 5
The move towards care in the community 5
The Health Authorities Act of 1995 6
Towards a primary care-led NHS 7
Other government initiatives 8
The trend towards mergers 10
Summary 12
References 12
2 The case for rationalization of acute care beds 13
Introduction 13
The international scene 13
The history of hospital growth and building in the UK 15
Major reasons for the rationalization of acute care beds 15
The increase in emergency admissions 22
The increase in hospitalization 23
References 24
3 The future of the acute care hospital and the importance of
strategic thinking 25
Introduction 25
NHS priorities and planning guidance 25
The future organization and structure of acute care 26
The CaIman Report on cancer services 29
vi Rationalizing acute care services
Responsibility for implementing the future structure 31
The role of the acute care manager 32
The case for strategic thinking 33
Obstacles to strategic thinking 35
The information required to support strategic thinking 35
References 36
4 Understanding the catchment population 37
Introduction 37
Defining the catchment area 38
Verifying the catchment area 38
Reviewing the population of the catchment area 39
Health characteristics of the population 41
Health care needs assessment 43
Planned changes in the area 45
Targeting populations outside of the catchment area 45
Reference 45
5 Analysis of current patient activity 46
Introduction 46
Contracts with purchasers 46
Total patient activity 48
Ward analysis 48
Specialty analysis 50
Bed census 52
Audit Commission indicators for monitoring the use of beds 53
Review of competition 55
Summary of patient activity 57
Reference 57
6 Projecting bed needs 58
Introduction 58
Building a hospitalization model 58
Comparison of beds required with beds available 60
Projecting bed needs 61
Scenario planning 64
Other major factors to consider 65
Determining beds by the number of patient episodes 67
Summary 67
Reference 68
7 Site and facilities appraisal 69
Introduction 69
Single versus multiple sites 69
Estates' functional content and space utilization 70
Contents vii
Site constraints 72
Condition appraisal 73
Site services appraisal 74
Statutory requirements 74
Location and accessibility 75
Patient focused care 76
Future implications for acute care health facilities 78
Consideration of options 79
Reference 79
8 The costs of rationalization 80
Introduction 80
The analysis of options 80
Costing the options 82
The private finance initiative 85
9 Public relations, communications, and consultation 87
Introduction 87
The role of public relations in hospitals 88
Internal communications 89
Openness and clarity 90
The public consultation process 91
The need for less but better consultation 92
The confusion between consultation and patient involvement 93
References 94
10 Future uncertainties 95
Introduction 95
Alternative health policies 95
The private sector 98
Priorities and rationing 99
Evidence-based medicine 100
The era of cooperation between competing providers 101
Conclusion 102
References 103
Index 104
Preface
The management and financing of health care systems throughout the world is
in a state of flux. Burgeoning demands for health care services resulting from
greater awareness and higher expectations on the part of users as to the quality
and timeliness of service provision; rapid technology change and capital
intensity; as well as profound changes in demography are putting both public
and private health care systems under considerable stress. In most developed
countries expenditures on health care consume between 7-15 per cent of
national income. Unless improved management and higher efficiency levels in
the provision of health care services are achieved, present trends suggest that
adequate and timely health care will become less and less affordable at the
level of the individual, as well as societies. In some cases health care systems,
unless radically changed, will break down.
Growing demand for health care comes at a time when governments
confront dramatic resource constraints. With a squeeze on public budgets in
virtually every country in the world, ways need to be found of de-linking
health care from total dependence on government financing, in an acceptable
manner. No civilized society can seriously contemplate the complete
abdication of public responsibility for a basic level of health care; especially
for the elderly, the infirm, and the poor. At the same time no society can
ignore the fact that, with public preferences for much lower levels of direct
and indirect taxation, more and more of the burden of paying for health care
services will need to pass from the state to private families and individuals.
That shift has major repercussions and implications for how health care
resources are to be allocated and distributed, and how they are to be managed,
so as to achieve an acceptable degree of convergence between growing
expectations and actual delivery of services. This book attempts to focus on
one aspect of that fundamental issue in the UK; the rationalization of acute
care services.
The rationalization of acute care services is taking place all over the country
and in many places is plagued with public opposition and misunderstanding.
In the following chapters the need for rationalization is discussed in the
context of the NHS reforms and a strategic thinking approach. The processes
Preface ix
involved in any exercise in rationalization are outlined from the initial defining
of the catchment population, planning service levels, determining costs and
estate and capital implications, to handling public relations and public
consultation, and dealing with future uncertainties such as policy changes
accompanying a possible change in government.
The text is essential reading for managers and clinicians involved in acute
care services, non-executive members of boards and trusts, and students of
health services management.
If this book makes a small contribution towards an improved understanding of
one of the major issues being faced in acute care services - the rationalization
of services - it will have achieved its purpose.
Pauline Mistry
August 1996