BMJ 2014;348:g2416 doi: 10.1136/bmj.g2416 (Published 27 March 2014)

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NEWS NHS hospitals should imitate Sainsbury’s Local and Tesco Metro, hospital chief says Nigel Hawkes London

The NHS is “close to being overwhelmed,” the UK shadow health secretary has said. Speaking at a meeting organised by the Reform think tank for the Shelford Group of leading academic hospitals, Andy Burnham said that problems in accident and emergency (A&E) departments were a barometer of wider pressures on health and social care as a whole.

“If there is a blockage anywhere, it will be seen in A&E,” he said. He noted that cuts to general practice and community care, as well as to local authorities and social care, had placed hospitals under increasing pressure.

“Can they carry on and never drop the ball?” Burnham asked, claiming that A&E targets had been missed for 35 weeks running and that more than a million patients had waited longer in A&E than the target maximum of four hours. “I think if you look at A&E it is telling you the system is close to being overwhelmed. Hospitals are in a very difficult position, and we’re expecting too much of them.”

The junior minister at the Department of Health, Dan Poulter, had earlier painted a very different picture. He admitted to “huge pressures” but also claimed successes, such as the recent deal to set a limit on the cost of drugs to the NHS and the “real improvements” in care being achieved by clinical commissioning groups. Poulter focused on plans to improve NHS procurement and open up hospitals to full financial transparency. “We don’t know how spending varies by hospital,” he said, “and that should all be in the public domain. We have mandated full transparency from next month; that will show which hospitals deliver and which do not.” He cited the use of temporary staff, which he said varied greatly and which, if reduced, could save the NHS £450m (€540m; $745m) a year. The half day conference at the Royal College of Obstetricians and Gynaecologists offered the 10 organisations of the Shelford Group an opportunity to report their successes, offer any gripes about national policy, and outline their vision for the future.

For Julie Moore, chief executive of University Hospitals Birmingham NHS Foundation Trust, this meant smaller hospitals surviving under a bigger brand, just as Sainsbury’s Local and Tesco Metro had replaced the dwindling corner shop by combining localism with centralised buying power. “We need a similar kind of development in health, where large centres provide a comprehensive range of all services at a major campus For personal use only: See rights and reprints http://www.bmj.com/permissions

but also deliver a more limited range of clinical services in the district general hospital setting at the same quality and price,” she said.

Mike Deegan, of Central Manchester NHS Foundation Trust, thought that the key was joint ventures, or the outright acquisition of failing hospitals by successful ones. “We acquired Trafford Hospital, a small [district general hospital] with a £19m deficit, did a clinical and financial review, and took out £5m of costs on the first day,” he said. “Now the hospital is focused on what it does well, and mortality ratios are below the national average. Acquisition is not universally popular, but it does offer a way of sustaining a viable local hospital. Is the model exportable? Definitely, yes.” Len Fenwick, of Newcastle upon Tyne Hospitals NHS Foundation Trust, said that the future would be about vertical integration, with hospitals taking over primary and community care. His programme in Newcastle was not about empire building, he insisted, but working in the community with all providers to improve care.

Admissions for urinary tract infections had fallen by 60%, and in the most recent quarter emergency admissions for chronic obstructive pulmonary disease were down by 13%, Fenwick said. He denied that this was a threat to primary care, saying, “No foundation trust can thrive where primary care is failing.” He added that integrating care in this way did not require legislation, could be done within existing financial allocations, and required only “a nudge” from NHS England. It was Burnham, however, who spoke with the greatest conviction, accusing the coalition government of making three fundamental mistakes: ringfencing NHS spending while social care spending was falling, legislating for changes that could have been achieved more easily without legislation, and preventing collaboration between hospitals by an ideological commitment to competition.

He reiterated his plan for the full integration of health and social care, with health and wellbeing boards acting as commissioners to create a “whole person” service provided by acute trusts. Where did primary care fit into this picture, he was asked? Burnham responded, “If the primary/secondary care divide disappears, it wouldn’t be a bad thing.” Cite this as: BMJ 2014;348:g2416 © BMJ Publishing Group Ltd 2014

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BMJ 2014;348:g2416 doi: 10.1136/bmj.g2416 (Published 27 March 2014)

Page 2 of 2

NEWS

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NHS hospitals should imitate Sainsbury's Local and Tesco Metro, hospital chief says.

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