Acute medical care in England: Findings from a survey of smaller acute hospitals

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


Published: 13/09/2018

Download the slide deck [PDF 481.2KB]

Millions of people across England rely on smaller hospitals as their first recourse in an emergency and their first source of specialist expertise when chronic conditions worsen. But these hospitals are facing increasing challenges in providing immediate specialist care for patients attending hospital in an emergency with a wide range of medical conditions.

The Nuffield Trust conducted a survey of smaller hospitals to assess the current state of acute medical care. We interviewed medical directors and lead clinicians for acute/emergency medical care over a six-month period and found evidence of the huge challenges faced by smaller acute trusts in England, particularly in maintaining sufficient numbers of medical staff.

Across the country a stark variation in staffing numbers, roles and specialties prevails, and there is little correlation between the skill mix of specialists within these hospitals and the patient cases that are being dealt with. The configuration of acute medical services is becoming increasingly fragmented and complex, with patients being hived off into more and more specialist units of care.

The survey responses indicate that acute trusts are aware of these issues and are continually experimenting with new approaches and ways of working in an attempt to address them. Some are short-term fixes; others are more medium and long-term solutions. But no trust felt they had the ‘ideal’ model of care or anything very close to it.

Suggested citation

Imison C and Vaughan L (2018) Acute medical care in England: Findings from a survey of smaller acute hospitals. Slide-set resource.