Acute hospitals and integrated care: From hospitals to health systems

A core part of the vision in the NHS five year forward view is a fundamentally different role for acute hospitals. Hospitals in England and elsewhere face significant challenges as a result of rising demand and the changing needs of the population, and they will not be able to meet these challenges by continuing to work alone. Instead, acute trust leaders need to embrace a system-wide perspective and work increasingly closely with primary care, community services, social care and others.

In some areas of the country this change is already well under way, with hospital leaders taking a shared responsibility for leadership of a local system. This report describes lessons from five case studies where acute hospitals are working collaboratively with local partners to build integrated models of care – three of these sites have since been chosen as vanguards by NHS England. The report assesses the achievements made so far, distils the lessons learnt for other local health economies, and makes recommendations for national policy-makers.

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.

Policy implications

• 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.