Rethinking acute medical care in smaller hospitals

Rethinking acute medical care in smaller hospitals
Nuffield Trust 4 October 2018

• Smaller hospitals are struggling with workforce shortages, spiralling costs and increasingly complex models of care for acutely ill patients. This major new report outlines a set of radical new approaches for running acute medical services in these institutions and suggests we should avoid assuming that closure is always the answer.
• The report focuses on hospitals serving 140,000 to 300,000 people – in particular those that are geographically isolated.
• (See related Findings from a survey of smaller acute hospitals)

Survey of smaller acute hospitals - staffing and configuration findings

Acute medical care in England: Findings from a survey of smaller acute hospitals
Nuffield Trust 13 September 2018

• This profile of smaller hospitals in England finds trusts struggling to recruit and retain acute medical staff. The research indicates that services across the country are configured in a wide variety of ways, with little evidence of an 'ideal' model for acute medical care.

The role of hospital chains in the future NHS

The role of hospital chains in the future NHS
PwC 18 February 2016

• A hospital chain is a group of hospitals operating under the same strategic leadership.
• Using examination of hospital chains in Germany this report presents an interactive guide to hospital chains. It covers the key features and findings of an effective hospital chain (leadership, scale, efficiency and culture) and presents a call to action for the key players within UK health system.

Strategic place-based "systems of care" is the future of NHS commissioning

Place-based systems of care: A way forward for the NHS in England
Kings Fund 12 November 2015

• This paper proposes a new approach to tackling growing financial and service pressures felt by the NHS, arguing that NHS organisations need to establish place-based ‘systems of care’ in which they collaborate with other NHS organisations and services. Key to this approach is the development of strategic commissioning based on footprints much bigger than those typically covered by CCGs today.
• “Fundamental changes to the role of commissioners are needed to support the emergence of systems of care. Commissioning in future needs to be both strategic and integrated, based on long-term contracts tied to the delivery of defined outcomes. Scarce commissioning expertise needs to be brought together in footprints much bigger than those typically covered by CCGs, while retaining the local knowledge and clinical understanding of general practitioners .”
• "The starting point in establishing place-based systems of care is to define the population served and the boundaries of the system."
• “The case for strategic commissioning rests on the failure of commissioning to make a major impact in the NHS and the need to use scarce expertise as effectively as possible, not least to ensure that place-based provider collaborations are mirrored by a level of commissioning expertise that it is simply not possible to provide in more than 200 CCGs.”
• “Strategic commissioning will require thoughtful evolution towards a system in which the clinical expertise and local knowledge of CCGs are retained and where NHS commissioning is based on footprints much bigger than those typically covered by CCGs today.”
• The report describes existing examples of work to establish place-based systems of care on a more formal basis from across the NHS including York, Solihull, Isle of Wight, Morecombe Bay and Northumberland. 

Guide to healthcare in England

Guide to the Healthcare System in England
DH, 3 May 2013 (36pp)

• This guide explains organisations in the healthcare system and how they work together and includes the Statement of NHS Accountability.
• The Guide will be updated annually and  covers:
• providing care
• commissioning care
• safeguarding patients
• empowering patients and local communities
• education and training
• supporting providers of care
• the role of the Secretary of State for Health

Interactive map of CCGs

HSJ interactive commissioning map (Subscription required)

• Graphical presentation of the geography of the new NHS commissioning system from April 2013. 
• Includes CCGs by wave, CSSs, LATs. 
• For each CCG see authorisation progress, population, budget, deprivation index, emergency admission rate, elective admission rate.

All of the new bodies

Guide to new health and care system
DH, September 2012

• A brief introduction to the statutory bodies making up the new health and care system, explaining how they will work together in the interests of patients and communities.

Who commissions what?

Commissioning Fact Sheet 

NHS Commissioning Board, 31 July 2012

• An outline of services to be commissioned by CCGs, NHS Commissioning Board, Local Authorities and Public Health England.

Just one of the resources on the Resources for CCG s page of the NHS Commissioning Board website 

Impact of CCG size and configuration on leadersip and engagement

Clinical Commissioning Groups: size, shape and securing localism
NAPC, 8 Feb 2012

• An advisory paper prepared to summarise the key issues associated with size and configuration of CCGs and propose how they might be addressed to maximise clinical leadership and engagement in commissioning.