TY - JOUR T1 - Top-quality, coordinated clinical care seven days a week: an affordable vision? JF - Future Hospital Journal JO - Future Hosp J SP - 3 LP - 4 DO - 10.7861/futurehosp.3-1-3 VL - 3 IS - 1 AU - Timothy W Evans Y1 - 2016/02/01 UR - http://www.rcpjournals.org/content/3/1/3.abstract N2 - An aspect of the report of the Future Hospital Commission (FHC) that was considered controversial when it was published 2 years ago was the perception that medical generalism was favoured over the trend towards increased specialisation. This notion was an oversimplification of a complex problem. A compelling component of the evidence gathered by the FHC came from patients and carers, who were engaged at all levels of the exercise. It became clear that they found the tendency for multiple specialists, often with extremely focused areas of expertise limited to a single organ (or indeed a part of that organ), to come to their bedside, pronounce on that specific aspect of their care and then depart to be frustrating, notwithstanding the undoubted improvements in clinical outcomes such specialisation has achieved.In response, a central recommendation of the FHC was that a trained clinician would assume overall responsibility for managing and coordinating each patient's care. This role could be fulfilled by generalists, or delivered by specialists for part of their job plan. All those involved in producing the FHC report were adamant that maintaining and augmenting the access of patients to specialist care could not be compromised in the future hospital; the issue was merely that the coordination of these efforts and their delivery as part of a comprehensive care plan was often lacking. Robert Francis also emphasised this point in his report into the Mid-Staffordshire case, asserting that the responsibility for the delivery of a basic level of care to all patients needed to be … ER -