I presume the Deputy is referring to a report titled, Keeping the NHS Local – A New Direction of Travel, published by the United Kingdom Department of Health in January 2003. The conclusions and overall approach of this document are closely in keeping with those of the report of the national task force on medical staffing – the Hanly report. Keeping the NHS Local notes that patients want more, not fewer, local services. It highlights a range of possibilities for more localised services, including increasingly sophisticated day surgery and clinical networks supported by telemedicine links.
As in the case of the Hanly report, Keeping the NHS Local concludes that there is a need for change in delivery of accident and emergency and acute services in "smaller" hospitals. It proposes removal of 24-hour on-site surgical staffing, introduction of minor injury units and a greater role for local hospitals in delivery of day procedures, specialist outpatient care and diagnostics.
The NHS report argues – section 2.2.12 – that patients need, above all, high quality care and the best possible outcomes. It asserts that improving quality of care will always be an important factor in developing new configurations, with patient safety coming first, underpinned by research evidence and professional opinion section – 2.2.13.
Keeping the NHS Local highlights – section 2.2.15 – how important it is "that future service models allow working patterns that are compliant with the EWTD"– European working time directive. It stresses that "the nature of 24 hour services in a number of locations may need to change. Making greater use of networking between community minor injuries units and acute centres and other redesign approaches will be needed to ensure that people have locally accessible emergency care."
Keeping the NHS Local mirrors many of the recommendations of the Hanly report, noting – section 2.4.8 – that the pilot programmes to implement the EWTD, and many other hospital sites in the UK, are exploring opportunities for: nurse practitioners to provide a first on-call tier cover in medicine, surgery, accident and emergency and intensive care; senior house officers to provide cover across related clinical specialties e.g. surgery, trauma and orthopaedics and ear, nose and throat; pharmacy technicians to manage patient medicines; medical assistants to reduce the workload on doctors in training; surgical discharge led by nurses or other non-medical practitioners.