16.06.14
No clear evidence of poorer care in small hospitals – Monitor
There is no clear evidence that smaller acute hospitals perform any worse than their clinically larger counterparts, and there is an opportunity for them to “survive and thrive”, healthcare regulator Monitor has stated.
Its latest report – Facing the future: smaller acute providers – analysed a comprehensive range of clinical and financial indicators to test whether any special factors affected the performance of hospitals with fewer than 700 beds (typically in trusts with an income of less than £300m).
However, the analysis revealed that while it is encouraging that the small size does not in itself preclude hospitals from achieving sound performance, future developments such as guidance to increase numbers of permanent staff will put smaller acute providers under mounting pressure.
There is also evidence that smaller providers may be starting to face greater financial challenges, with performance worsening more than the sector as a whole in the last two years.
Monitor has, therefore, recommended identifying new models of care for patients, for example re-designing services to improve the integration of care and move it closer to home.
It also wants to make sure the right balance is struck in local communities between redesigning services and making sure patients are treated near to where they live.
It has also been suggested that building effective partnerships or networks between acute providers and major centres could become crucial to ensuring delivery of quality services in the future.
David Bennett, chief executive at Monitor, said: “People value their local hospitals and we wanted to understand the challenges that they face as the NHS takes on a potential £30bn funding gap over the next decade.
“We found that smaller hospitals are facing increasing challenges but with the system’s support can continue to play an important role in the nation’s health service.
“Bigger isn’t always better and just merging or taking a ‘one size fits all’ approach to local health services is not the answer.”
The announcement comes shortly after the new head of NHS England, Simon Stevens, called for a shift away from big centralised hospitals and a move towards expanding local services to treat people in their communities.
Responding to Monitor’s latest findings, Rob Webster, chief executive of the NHS Confederation, said: “This important report provides additional weight to the view that we need to stop obsessing about the size of organisations and start thinking much more about models of care. Small hospitals have a future as part of a whole system approach to healthcare.”
He added that along with everyone else, small hospitals will have to adapt the range of services that they provide, and the ways in which they do so, as they continue to be part of the offer of local access to healthcare.
Terence Stephenson, chairman at The Academy of Medical Royal Colleges, added that it is clear from the report that that there are no simple conclusions or answers to these questions. “But the report provides the service with a useful base for taking forward thinking and practical action,” he said.
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