Advancing Community Hospitals and Services in the NHS: Learning from International Experiences

Ellen Badger Community Hospital

Ellen Badger Community Hospital in Warwickshire

Photo by Lydia / CC BY 2.0

Background

In England, there are around 300 community hospitals, 219 of which have beds. A number of community hospitals have faced closure during the past ten years, and some still face uncertain futures.

At the interface between primary care and specialist care, community hospitals have the potential to play a major role in the management of acute and non-acute conditions. Despite this, community hospitals in England do not appear to have a defined role within the health system. They are often seen as being reactive to the needs of larger hospitals. Other countries by contrast have moved to formalise the role of community hospitals within their systems, which may provide valuable learning for NHS England.

There has been a growing interest in community hospitals in England as result of an increased focus on shifting services closer to people’s homes and delivering more integrated care locally. The NHS England’s Five Year Forward View says, “The traditional divide between primary care, community services and hospitals is increasingly a barrier to the personalised and coordinated health services patients’ need.” In this regard, there seems to be an opportunity for community hospitals within new care models being developed in England.

Goals

RAND Europe, the European Observatory on Health Systems and Policies and Bournemouth University were funded by the National Institute for Health Research (NIHR) to understand how NHS England can advance community hospitals and services in England learning from comparable hospital models in five other countries – Norway, Finland, Italy, Australia and Scotland.

Research Questions

  1. What is the nature and scope of service provision models that can be considered under the umbrella term ‘community hospital’ in the UK and other high income countries?
  2. What is the evidence of effectiveness and efficiency of community hospitals and comparable service models in the UK and other high income countries, including of patient outcomes?
  3. What is the wider role and impact of community engagement in community hospital service development and provision?
  4. How do models that are comparable to community hospitals in England operate and what is their role within the wider system of service provision in other countries?
  5. What is the potential for models that are comparable to community hospitals in England to perform an integrative role on the delivery of health and social care in other countries?

Methodology

The study developed a scoping and systematic review of the national and international evidence, and country-level analysis and case studies of community hospitals in the five countries.

Findings

The study found a number of benefits and challenges to community hospitals across the five countries:

Benefits

  • Provide a wide range of services, covering the entire spectrum of care provision, from preventative and primary care, through to inpatient and outpatient medical and surgical care.
  • Improve patient experience and satisfaction.
  • Closer to the patients’ homes.
  • Closer staff-patient relationships.
  • Staff value the key aspects of the community hospital setting, including ease of access and a sense of ‘homeliness’.
  • Offer a diversity of services that respond to the needs of the local population.

Challenges

  • Human resources (e.g. attracting suitable staff and maintaining a diverse skill-set) due to the locations of community hospitals, often in rural areas.
  • The tension with the overall health system and where community hospitals fit in.
  • The infrastructure to support community hospitals and integrated care (e.g. IT systems).
  • The cost effectiveness of community hospitals is not clear.

Conclusions

Overall, the evidence suggests that a more strategic role for community hospitals might be timely within NHS England.

There is potential for community hospitals to be better integrated into the current healthcare system in England to offer an effective and efficient alternative to acute hospitals and to provide health and social care closer to people’s homes.

However, NHS England will need to address the challenges associated with community hospitals directly. The question of cost-effectiveness is important, as there is limited evidence available. Workforce challenges in primary care may also mean that community hospitals will have to continue to evolve from traditional GP and primary care led models.