The Royal College of Physicians has published a report called Hospitals on the edge? The Time for action, which reports on the huge challenges that the NHS faces and with recognition that radical action will be required if the NHS is to meet the needs of patients in the future. The following are reported by the Royal College as being particularly challenging:  

Increasing clinical demand: there are fewer beds but a 37 per cent increase in emergency admissions  

  • Patients changing needs: nearly two thirds of people admitted to hospital are over 65 years old  
  • Fractured care: some patients are moved four or five times during a hospital stay  
  • Breakdown of out of hours care: studies show a 10 per cent increase in mortality at weekends  
  • Medical workforce crisis: recruitment into emergency care is becoming increasingly difficult and a quarter of medical registrars report an unmanageable workload

The Royal College offers some solutions, some of which are listed below:  

  • Redesigning services: it is accepted that redesigning services will improve patient care and this will require service reconfiguration. It is also accepted that reconfiguration must be clinically led and clinicians must challenge the way that their own services are organised  
  • A review of medical education and training: medical professionals must have skills and knowledge to deliver expert and holistic care for current and future patients  
  • The right mix of medical skills: emergency and general medicine must remain an attractive career option  
  • Improving the availability of primary care: this is an ever increasingly important issue especially when considering reconfiguration

Is this another report attempting to predict the conclusions of Robert Francis QC? In any event, it is refreshing to see that the Royal College of Physicians supports necessary reconfiguration of services and is encouraging its members to do the same.