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Feature Integrated Care

Hospitals without walls

BMJ 2013; 347 doi: (Published 12 September 2013) Cite this as: BMJ 2013;347:f5479
  1. Nigel Hawkes, freelance journalist
  1. 1 London, UK
  1. nigel.hawkes1{at}

A new report from the Royal College of Physicians suggests a radical approach to the problem of providing continuity of care for modern patients. Nigel Hawkes examines the details

Nothing galvanises a community so much as a threat to its hospital. For better or worse, hospitals embody the reality of the NHS for most people in a way that general practice, let alone community care, cannot match. They are as important to a local sense of wellbeing as churches used to be, and defended with all the fervour that once filled those empty pews.

Yet hospitals are not the solution but the problem, according to a new report from the Royal College of Physicians (RCP). “Conventional models of health service design in which a hospital site is the sole focus for the delivery of emergency, acute and elective services are dated,” it says.1 They cannot provide the integration, collaboration, communication, and information sharing needed to care for today’s typical patients, who are elderly, multiply morbid, dependent, and often confused. The circumstances that made the hospital the icon of care have changed, but the hospital has not changed with them.

The RCP’s Future Hospital project is a bold attempt to envisage a new role for the hospital. It is one in which physical and mental barriers dissolve: the walls that trap clinicians inside buildings and within professional silos are eliminated. Care is delivered where patients’ needs can best be met, by medical teams working with professionals from primary and social care. Expertise is available seven days a week, both in hospitals and in the community. In the report’s words: “The overriding objective should be continuity of care for patients, coordinated and delivered by a single consultant-led clinical team.” The hospital ceases to be “somewhere”; it becomes everywhere.

“We went through …

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