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Hospitals should be system leaders not ‘islands’

Acute hospitals will need to play a fundamentally different role within local health economies if the vision described in the NHS Five Year Forward View is to be achieved, a report argues.

The Forward View, which sets out how NHS services will have to change in order to deliver new models of care to meet the needs of the future, provides an opportunity for hospitals to lead the development of integrated care and improve the health of the population.

But to do so, says the King’s Fund report, hospitals must avoid developing a ‘fortress mentality’ in response to mounting service and financial pressures.

There is a danger that hospital leaders focus on safeguarding their organisations rather than the sustainability of local health systems more widely.

The report argues that acute hospital leaders need to look outwards to their local communities and work more closely with primary care, social care and community services to improve the health of the populations they serve.

This will need to include a bigger role for them in prevention and public health and greater collaboration with neighbouring hospitals to improve services for patients.

The report reveals that there are some parts of England where these developments are already under way, but others where significant changes are needed. In areas where more substantial progress has been made, acute hospital leaders have invested considerable time and energy in building relationships with community partners, often over several years, and in particular have needed to make sustained efforts at improving the relationship with local general practices.

Chris Naylor, Senior Fellow at The King’s Fund, said: “We are seeing an important shift in thinking in some acute trusts. Hospital leaders are telling us that they see their role increasingly in terms of system leadership, and that working closely with local partners is key to the survival of the services they provide.

“However, the picture varies across the country, and even in those areas where most progress has been made, there is still a long way to go before the new models of care described in the Forward View can become a reality. One critical area where rapid progress is needed is improving the relationship between hospitals and primary care – this has all too often held back successful integrated care.”

To ensure that these ways of working become widespread and support the vision set out in the NHS five year forward view, significant changes are also needed in how health services are paid for, regulated and commissioned.

The report recommends:

– developing a new regulatory model with greater emphasis on whole-system performance

– ensuring that competition law does not create barriers (real or perceived) to constructive dialogue and partnership working between commissioners and providers

– continuing to develop a range of alternative payment systems and support local commissioners in moving away from activity-based tariffs for hospital care

– introducing a transformation fund that ensures that all areas of the country are able to cover the costs of the transition to more integrated models of care

– creating more flexible job plans for acute care professionals that emphasise continuity across settings and joint working with other professionals

– developing more flexible contracting models for general practice to make it possible for acute hospital providers to take a greater role in primary care provision.

NHS Confederation director of policy, Dr Johnny Marshall, commented: “This welcome report reinforces what we have been saying for some time – that all NHS bodies, including acute trusts, need to look beyond the boundaries of their own organisation, and work with key partners, including local government, to improve the health and wellbeing of their local communities.

“There are many examples of this kind of leadership across the health service but we need Government to support this approach – stability is key to building these local partnerships. The next Government must avoid another top down reorganisation of NHS structures at all costs.”

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2 Responses to “Hospitals should be system leaders not ‘islands’”

  1. Malcolm Morrison says:

    In other words, the ‘system’ should be designed to meet the needs of the patient (and sometimes the wider public) – or ‘patient-centred’ to use the ‘in’ phrase’!

    Thus, the NEEDS of the patient must come first. These will be both ‘medical’ (to include nursing and other proffessional care) and ‘social’ (thought often the lines between the two are blurred). The funding and the SYSTEM should be designed to facilitate this – not the other way round, as it is at present!

  2. Cynical says:

    This is too sensible approach to be adopted by the system. This needs to be driven by NHS England and CCGs with real energy. It is possible that the trusts may not take this on the board at all. Everyone looks after their own turf! I am working in the system for 20 years, it is full of perverse agendas. Many times the welfare of the pt is completely forgotten. Without central drive this is unlikely to happen.

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