Fragmentation and Kindness?

You might say that Stafford is currently faced with “re-configuration” of its Hospital service is because a number of people experienced care which they felt was unkind. As I look at the recommendations from the Trust Special administrators about the future of the service  a key question I am asking myself is "will this improve the chances of people being treated kindly"?

As an aid to asking these questions I am currently reading “Intelligent Kindness” which was written by John Ballatt and Penelope Campling as a reaction to many of the issues raised by the first Francis report.

There are so many powerful points in this book. This is selected almost at random. (P88 In the chapter Co-operation and fragmentation. Pulled in all directions. )

The writer’s parent was being assessed for a knee operation. She asking how long her hospital stay would be. The answer she got was that it all depends on which CCG you come under. If it is “city” then she would be discharged when clinically ready, if it was “community” then it would be after 2 days. This is because “community” CCG had commissioned community based care for people being discharged home.

The writer then goes on to think about how confusing this must be for the staff of the ward dealing with patients in the next bed to each other, and the same conditions, but being given aftercare in completely different ways, and how this confusion would communicate itself to the patients and their relatives.

The underlying point I would make is that a patients experience of treatment is made up of their whole "pathway". Diagnosis, preparation, treatment, aftercare, discharge. These all need to work together, and there are many barriers that make this difficult.

If more acute care is being directed to super hospitals (determined by “financial and clinical sustainability”) then each  hospital will serve patients from a large number of different Clinical commissioning groups, each with their own service level agreements. If this is so then you are adding a whole new layer of complexity to the work that the staff must do. Staff will in the above example also be aware that failure to discharge patients on time if they are “community” patients will incur financial penalties. This creates additional pressures for them. Will any of this add to kindness?

Commissioners will aim to reduce the length of hospital stays, so we can expect that periods is an acute ward will be as short as possible, this might then be supplemented by a stay in a step down ward, (I am not sure that we understand enough about this, what are the rules about how step down beds will be used? How will they be paid for? Are they time limited?) Will that add to kindness?

The aim will be to discharge to the community as quickly as possible, but how good are the services to support people when they are discharged? Will that add to kindness?

How well does the centralisation of acute care, coupled with the fragmentation of commissioning and of local service provision actually work together in practice?

What patients want is to be supported at each stage of their “pathway” by teams that co-operate effectively.  Will the new model of hospital care that we are moving towards make this more or less likely?