Westminster think tank Re:State (formerly Reform) has published the third paper in its ‘Hospital of the Future’ series, a programme founded on the premise that the future of the NHS rests on reinventing the hospital.
‘Ending the Patient Gridlock’ addresses the problem of patient flow and analyses the issues that prevent the efficient movement of patients into and out of the hospital. Delayed discharge of patients who are medically fit to leave has become a significant problem, contributing to bed blocking that prevents new patients being admitted.
Re:State cites figures from February 2025, at the height of winter pressures, that state there were on average 13,740 patients stuck in hospital – the equivalent of nearly 23 hospitals’ worth of inpatients.
Patient flow, it says, has become the “Achille’s heel of modern hospitals.” Finding a solution to this problem is one of the NHS’s greatest untapped opportunities, with the potential to expand capacity without adding beds, improve safety and quality of care and create the foundation for an efficient and productive hospital.
Ending the gridlock
The paper proposes 25 recommendations to move towards a hospital model where patient flow is optimised. The recommendations address three key areas: aligning capacity and demand; operational inefficiency and internal bottlenecks; and bottlenecks at the back door. Recommendations include:
• Capital reform
Building on existing reforms in the 10 Year Plan, efforts to simplify and speed up capital approvals should be accelerated by introducing statutory or contractual deadlines for approvals with clear maximum timelines to avoid unnecessary delays.
• A new clinical specialty – the hospitalist
This model, long established in the United States, trains doctors to take charge of whole wards of patients whose conditions cut across multiple specialties. These are the complex, multimorbid cases that fall between the cracks of traditional hospital medicine, who make up an increasingly large portion of demand. With a hospitalist, patients could receive a clear, coordinated clinical decision from a single doctor within hours, rather than waiting days for four different specialists.
• A seven-day discharge workforce
The mismatch between seven-day admissions and five-day discharges creates a constant logjam at the back door of the hospital – weekend discharges are 40% lower than on weekdays. This does not mean making the entire workforce work on the weekends: just those essential to discharge. This includes pharmacists, occupational therapists, social workers, as well as empowering more nurses to make decisions to discharge.
• More and better operational managers
They are often criticised, but managers are essential to the operational efficacy of a hospital. However, the NHS does not have enough of them, and often they are not trained properly. Re:State proposes creating a professional body, similar to the General Medical Council, for NHS management, alongside a professional accreditation.
