'What is the future for smaller hospitals in the NHS?' This seems a bit of a strange question to pose in these cash-strapped times: a system struggling to maintain safety and quality amid rising demand from patients with increasingly complex needs, run by a workforce spread thinner than anyone would really like.
The obvious answer is to centralise wherever possible, take advantage of economies of scale, use your workforce flexibly and strip out cost. Problem solved.
But what if, like here in Northumbria, your 500,000 people (a key critical mass) are spread across 2,500 square miles (yes, 2,500 square miles), with some living 80 miles from their nearest acute unit? A model that might be appealing to an urban system does not really work here. We need to be a little bit creative.
The first step is to ask, whatever its size, what is your hospital trying to do? What are the services it can safely and sensibly deliver? The traditional system – where smaller district general hospitals attempt to provide a complete range of services by specialist teams with staffing pools too tight to make sensible rotas – cannot continue.
The idea that a workforce can be managed flexibly across a rural patch and moved at short notice just will not work. Staff are part of their rural community and deliver loyal service above and beyond the call of duty in our experience. That must be supported and developed. If they are not used locally, the value of that workforce will be lost.
The expectations of a population can, I believe, be influenced by honest and open discussion. Data – leading on to education – can be used to explain to the public what is actually deliverable, as opposed to what may be theoretically desirable, to allow new models of safe and efficient care provision.
Smaller hospitals must be viewed not just as 'mini-large' hospitals, but as discrete entities delivering niche products and services. Northumbria's are factories for carefully case-selected day surgery, and as many outpatient and diagnostic functions as can be squeezed in. They have a small number of inpatient beds for the active rehabilitation of mainly older people in their own communities. All of this seems to have worked for us.
We have six smaller hospitals in Northumbria now, and long may they continue.
It is also important to try working with local authorities to co-locate supported living services and community-based staff offices. We are even building a fire station on one site as well. We are constantly looking for ways to maximise function and preserve viability. Rural communities expect it.
It might even work for some urban areas too, if people dare to be creative enough. Fancy trying?
On 12 July, David Evans will be contributing to our expert panel debate Daring to ask: is there a future for smaller hospitals in the NHS? The debate, the second in our series with the NHS Confederation, will consider the evidence for centralisation and the role of smaller hospitals in the current financial climate. The event will be live-streamed on our website, where you can find more details about speakers and agenda.
Evans D (2016) ‘What is the future for smaller hospitals in the NHS?’. Nuffield Trust comment, 8 July 2016. https://www.nuffieldtrust.org.uk/news-item/what-is-the-future-for-smaller-hospitals-in-the-nhs