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The squeeze on hospitals

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There is a shift occurring in howcare is delivered which will leave some hospitals squeezed, and the grip islikely only to get tighter.  Going is thetraditional belief that illness is best treated in general hospitals, andcoming is an approach which pushes care out into the community and encourages thedevelopment of specialist centres.

You will have guessed that cost is onereason why - hospitals are expensive. But more interesting is the potential for care at home to lead to betterhealth outcomes than those achieved in hospital.  It's not suggested that this will beappropriate for all patients.  The NHSConfederation estimates that at least 25% of patients could be better lookedafter at home.

The government is currently pilotingTelehealth.  This is where a patient's vital signs are monitored remotely at their homein real-time by healthcare professionals. This enables timely interventions to be made, such as increases in doses,without the patient having to visit a clinic. As patients can also monitor their own health, they report feelinggreater control over it.

Initial indications suggest Telecarereduces hospital admissions, the number of days spent in hospital and the timespent in A&E.  But most strikingly,it reduces mortality rates by 45%.  Theinitial results have been showered with superlatives, including by the prime minister.  I think it's safe to assume we'll be seeingmore of it in the future.

When patients move into thecommunity, the money moves with them. This can leave hospitals struggling. This will inevitably lead to some hospitals closing, something which isalways very politically difficult.  Politiciansfear being ‘Kidderminstered', in reference to a campaign to save a local hospitalwhich resulted in the MP for the area losing office.  It has been argued that there should be amore rational approach to hospital closures, but it has yet to be implemented.

It remains to be seen if thepublic can be sold hospital closures on the promise of improved care, and ifnot, whether the government will hold its resolve.  Either way, some hospitals, particularly the traditional district generals, face an unclear future.

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