It would mean ripping up the £20bn New Hospital Programme and moving to a more nimble model to improve outcomes and reduce cost pressures.

The proposals form part of a new paper published by the Social Market Foundation think tank and authored by Nick Bosanquet, former professor of health policy at Imperial College, and Andrew Haldenby, an advisor to public service organisations.

Titled ‘A new lease of life: Three steps to success for the NHS’, the paper suggests the NHS is drifting towards a three-tier system: worst in deprived areas, better in affluent areas, and with more people opting for private care. Maintaining the district general hospital model prevents policymakers from addressing Britain’s changing health needs and obstructs the NHS from making necessary efficiencies, the paper asserts.

Reducing hospital admissions

Bosanquet and Haldenby set out a plan for a more efficient NHS, featuring teams led by GPs and including physiotherapists and counsellors, with specialist ‘dynamo’ operating centres helping to reduce hospital admissions.

Investing in this model, however, would mean scrapping the New Hospital Programme, which entails building 40 new hospitals in England but has been beset by delays and rising costs. Bosanquet and Haldenby argue that its funds should be used to invest in a modern hospital system featuring local GP-led teams of health professionals managing all out-of-hospital services in an area. These ‘neighbourhood teams’ would be tasked with reducing hospital admissions by 30 per cent.

Under the proposed model, a patient could be treated by their neighbourhood team of healthcare professionals at home, resulting in a more cost-effective outcome than hospital-based care, with the potential to treat four times as many patients in a month. Neighbourhood teams would also maintain continuity of care, which is becoming a more important requirement, given the rise in long-term conditions which have physical and mental health elements.

Neighbourhood teams would be complemented by dynamo centres, with more operating capacity than the new surgical hub units, and they should be modelled on the highly rated South West London Elective Orthopaedic Centre. These dynamo centres would be highly specialised and treat a large enough area such that 24/7 staffing by consultants would be viable. Specialisation and concentration would boost output and success rates, ultimately bringing down waiting lists, the paper concludes, with the remaining district general hospitals left to focus on providing A&E services and work with neighbourhood teams.

Nick Bosanquet, co-founder of Aiming for Health Success, said: “The NHS’s enormous current resources can deliver a faster, better service within months, even in a climate of great pressure on public spending.”

His co-founder of Aiming for Health Success, Andrew Haldenby, added: “Ministers are using strikes as a convenient excuse for rising waiting lists. The NHS has talked about the right kind of change for years, but progress has been glacial.”

Data and funding

They also recommend that data on the costs and productivity of different services should be routinely collected and published to drive change in services and development. Integrated care services should be given control over their capital spending, they add, with dedicated funds for maintenance and development than can be carried over from one year to the next.

Commenting on the plan, Jamie Gollings, deputy research director at the Social Market Foundation, said: “Addressing Britain’s changing healthcare needs while delivering better value for public money is challenging, but possible.

“The plan Bosanquet and Haldenby lay out requires great political will to shift our focus away from the traditional hospital model, but there are existing examples to learn from that show how it can be changed. Their paper shows how we can build greater and swifter operating capacity and deliver more healthcare in the community, and cut our losses on the increasingly delayed and burdensome New Hospital Programme.

“The hospital must become a last resort for patients, and they must have avenues for care that pre-empt and avoid it.”