Partnerships the key for Acute Trusts, says new Kings Fund report

Acute hospitals and integrated care: from hospitals to health systems describes five case studies where acute hospitals are working in collaboration with local partners to develop integrated models of care. The report is the result of the NHS Five Year Forward View, which sets out an overall vision for better health services in the UK. A core part of this involves acute hospitals becoming better harmonised with other forms of care.

Key findings:

• The successes seen in the case study sites have only been achieved after several years of sustained effort, with a particular emphasis on building the necessary relationships and trust.

• Whole-system governance structures involving acute hospital providers and other local partners can support the development and rapid implementation of integrated models of care, drawing on resources and expertise from across the local health system.

• A major challenge identified was engaging primary care within these shared governance structures. In cases where progress had been made, acute hospital leaders had invested considerable time and energy in building relationships with general practice.

• There was some evidence that integration of acute and community services within a single organisation can facilitate the implementation of integrated care models, but many of the same benefits can also be achieved through successful partnership working.

• Hospital leaders in the study believed that integrated service models would help to manage growing demand within existing bed capacity, rather than achieving any significant reduction in bed numbers.

The five hospitals used for the case study were Northumbria Healthcare NHS Foundation Trust, Sheffield Teaching Hospitals NHS Foundation Trust, Airedale NHS Foundation Trust, Yeovil District Hospital NHS Foundation Trust, and South Warwickshire NHS Foundation Trust. Each site was recognised as having made encouraging progress in developing more integrated models of care.

Responding to the King’s Fund report, NHS Confederation director of policy, Dr Johnny Marshall said: “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."

Report policy recommendations

• Acute sector leaders should be encouraged and supported to take a leadership role in their local health systems, working with local partners to develop more integrated models of care, and taking greater responsibility for prevention and public health.

• Supporting actions at various levels are needed: including a regulatory model with greater emphasis on whole-system performance; a nuanced approach to competition that does not create barriers to constructive dialogue and partnership working between commissioners and providers; and more flexible contracting models for general practice.

• There is a need for realism regarding the pace of implementation of new models of care. Even in local health economies where integrated working is well advanced, the current situation is a long way from the vision described in the NHS five year forward view.

To read the full report