Key points
- The term ‘acute care’ derives from an earlier period when patients were seen through the acute stage of their illness in hospitals and often then transferred to other settings. Nowadays it comprises all the main activities carried out in hospitals such as emergency treatment and a wide range of elective treatments, most of which can only be carried out by highly trained staff and using special equipment.
- Acute hospital services are provided by 173 trusts, of which 82 are foundation trusts. Foundation trust status is a new form of public ownership known as an independent public benefit corporation. These trusts are not subject to direction by the Secretary of State and their boards are elected by their staff and the people they serve. Although they enjoy substantial independence, they are required to use their assets primarily to provide care for NHS patients.
- NHS and foundation trusts provide almost exclusively acute hospital care. Primary, community and mental health services sit within separate organisations. An issue of ongoing debate is whether this separation of acute hospital services provides a significant barrier to more integrated care for patients. A number of acute trusts are exploring options to provide an extended range of services in the community as the model of care shifts to one that is more community based.
- Each acute trust has one or more acute hospitals and generally serves a local catchment population of around 200,000-500,000. Generally, acute hospitals have distinct local catchments drawing most of their activity from those that live within a 10-15 mile radius. However, since patients have been able to exercise choice in elective care this is changing, particularly in the larger urban areas where patients can travel easily to a range of hospitals. Total expenditure on acute services is a little over 40 per cent of the total NHS budget.
- Acute hospitals treated about 13.5 million patients in 2007/8. Of these, about one third were emergencies, one third elective cases and one third maternity and other categories. Nearly 5 million patients were treated as day cases.
- The number of acute beds has remained at about 100,000 over the past ten years. The average inpatient length of stay was 5.7 days in 2007/8, compared to 8.4 days a decade earlier.
- Acute trusts employ nearly 35,000 consultants and a similar number of registrars – just over half of the total NHS medical staff. They employed over two-thirds of the total nursing workforce of 315,000 in 2008.
- The NHS Plan, published in 2000, set a target of 100 new (ie, rebuilt) hospitals by 2010 as part of its wider programme for modernising the NHS. This target has been exceeded. Currently 104 schemes (77 financed through the private finance initiative) are operational and a further 28 are under construction.
- The Local Government Act 2000 provided for the establishment of Oversight and Scrutiny Committees by local authorities. In 2002 regulations were issued that gave local authorities the right to conduct inquiries into the health services used by their residents.
- The NHS Act 2006 requires that all NHS bodies involved in service change must involve service users or their representatives in planning service changes and making decisions on them.
