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JUL 11/2014

Could smaller hospitals help to improve care standards in the NHS?

NHS hospital workers could be set to see a major systemic shift in the coming years as the government gradually begins to awaken to the potentially significant value of smaller local hospitals.

In recent years, there has been a general NHS trend to focus on creating larger hospitals that can house as many patients and services as possible. However, the evidence is growing that adopting a more diverse approach could have a number of possible advantages.

As such, NHS staff could once again see small hospitals being seen as a vital part of the overall structure of the health service - although those in charge of running these facilities will need to find ways to improve their performance if their full potential is to be realised.

The growing recognition for smaller hospitals
The push back towards smaller, cottage-style hospitals was highlighted by the newly-installed NHS England chief executive Simon Stevens in an interview with the Telegraph last month.

Marking a reversal of recent strategic policy decisions, Mr Stevens said hospitals of this kind can aid wider efforts to return to treating more patients in their local communities, a model that has proven to be effective in countries such as Sweden, the Netherlands and the US.

"A number of other countries have found it possible to run viable local hospitals serving smaller communities than sometimes we think are sustainable in the NHS", he said.

This concept received further support earlier this month in a report from Monitor, in which economists from the regulator analysed a range of clinical and financial indicators to test whether any special factors affected the performance of hospitals with fewer than 700 beds.

It found no clear evidence that smaller acute district general hospitals performed any worse clinically than their larger counterparts.

Improvements still to be made
However, the Monitor analysis also indicated that smaller providers have a number of issues to remedy before they can truly step up to the plate and become key providers of essential care.

It revealed evidence that smaller providers have faced greater financial challenges that are impacting performance more than the sector as a whole in the last two years. This will likely be a growing trend as hospitals face greater pressures to recruit staff to improve their quality of care.

As such, a number of efficiency improvement methods and reform concepts were proposed that would allow smaller facilities to make optimum use of their resources. For example, innovative new models of care could be introduced, such as re-designing services to move them closer to home and offer greater integration.

Sharing staff with nearby trusts, adopting new technology and building networks between smaller hospitals and major centres, meanwhile, can help to address scale challenges.

David Bennett, chief executive at Monitor, said: "Bigger isn't always better and just merging or taking a one-size-fits-all approach to local health services is not the answer. We need to achieve the right balance between risks to quality and risks to access, and consider other constraints such as the impact of clinical specialisation to make sure patients continue to benefit from the local hospitals that they value so much."

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