Centralisation of specialist health care services

This is a RSET project (Rapid Service Evaluation Team), a collaboration between the Nuffield Trust and UCL and funded by NIHR.

There have been significant changes in the provision of specialist clinical care in the NHS in recent years, with plans to centralise specialist services into fewer centres. Specialist services are not available in every hospital because specialist teams of health care professionals with the required knowledge, skills and experience usually deliver them. There have been longstanding recommendations for centralisation of specialist services. There are two parts to this study. The first part will be to undertake a review of the literature to investigate how the centralisation of specialised health care services in the UK can be characterised. The second part will be an empirical study to be undertaken with the planners of the new Cambridge Children’s Hospital (CCH) to investigate the centralisation and integration of physical and mental health services for children. The aims are to

(1) Investigate how the centralisation of specialist health care services in the UK can be characterised,

(2) Use qualitative and quantitative methods to support and inform the planned integration of physical and mental health services for eating disorders and for functional symptoms at Cambridge Children’s Hospital.,

(3) Make recommendations that will guide the implementation of these services, and

(4) Identify lessons that will guide the reconfiguration of specialist services into integrated models of care elsewhere in the NHS.

The objectives are:
O1. To undertake a novel scoping review to identify what “centralisation” as a service innovation means in the context of specialist health care services, and what the dimensions of centralisation are.

O2. To use the scoping review to develop a taxonomy to map the different models of centralisation.

O3. Undertake a rapid systematic review of the literature on centralisation and integration of physical and mental health services for eating disorders and for functional symptoms that supplements other ongoing work.

O4. Undertake a documentary analysis to delineate the current and planned pathways of care and identify key stakeholders related to the planned changes at CCH.

O5. Develop a logic model describing the anticipated impacts of the planned changes.

O6. Undertake an economic analysis using economic modelling to evaluate the impact of the planned pathways of care identified in objective b in terms of effectiveness and cost-effectiveness, including exploring the uncertainty in these findings. This would explore potential savings (e.g., in terms of time, resources, distress, costs of travel, etc.) by centralising services from different viewpoints (e.g., NHS, families) balanced against the costs of centralising care.

O7. Examine preferences for centralisation among families and professionals using qualitative research and discrete choice experiments.

O8. Undertake qualitative research to investigate the factors that may influence implementation of the new models of care at CCH.

O9. Identify lessons learned that might be applied to future service changes of this kind. This is a mixed methods study comprising a scoping review of studies examining the centralisation of specialised health services, and an evaluation of the integration of specialised services for eating disorders and functional symptoms in children and young people, comprising a systematic review, economic analysis, examination of preferences for centralisation using qualitative research and discrete choice experiments, and qualitative research to investigate the factors influencing implementation of new models of care. 

The research is being developed in partnership with research users, to maximise its usefulness and impact. It will provide new data on what patients, the general population, health care professionals, hospital managers and commissioners think about the centralisation of specialist services, which issues matter to them the most when considering this, how strongly they feel about these issues. Results of this research will inform the integration of physical and mental health services for children at CCH and elsewhere in the NHS.

Full study protocol for this evaluation

Outputs

Presentations: 

• HSRUK 2023 Conference workshop: Integration of physical and mental health services for children and young people with eating disorders and functional symptoms: A qualitative evaluation of service re-design – watch here

Project team

• Steve Morris
• Efthalia (Lina) Massou
• Josefine Magnusson
• Saheli Gandhi
• Angus Ramsay
• Naomi Fulop

Back to RSET homepage