Acute hospitals and integrated care: From hospitals to health systems

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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.

Video summary

Hugh Alderwick, co-author of our new report on acute hospitals and the role they have to play in integrated care, gives a short summary of the findings of the report. He looks at the various forms of integration, the achievements reached in the report's case study sites so far and the implications for acute hospitals in the future.

Towards integrated care systems

The NHS long-term plan set the ambition that every part of the country should be an integrated care system by 2021. Through our series of events, you'll gain expert guidance and practical insights from those leading the way to help you prepare for the transition.

Learn more


Nazlee Siddiqui

University of Tasmnia
Comment date
18 February 2017
I am a researcher of this topic.

Pearl Baker

Carer/Independnet mentalhealth Advocate and Advisor,
Comment date
10 April 2015
back to basic, why! if the patients has no access to medication due to bank Holiday closure of designated Pharmacy and you have a 'dosett' boxes of medication for 28 day and it ends on the Sunday, you are in trouble.This is fundamental to good mental health planning.

Action! visited the Pharmacist now Wednesday who agreed there was a problem and agreed to contact the Surgery for another prescription that would provide medication from Thursday until Sunday, when the usual format from Monday until Sunday would start. They will always order two weeks in advance, and have a week supply in reserve.

As it happened this patient my son, had some lying around, hence why I suggested the 'dosett' box. It informs you when to take the medication, it also acts as a reminder, and also that the medication dispensed is the correct one, by actually describing to the patient what they look like. The Pharmacist will also have a regular check that this is the correct medication. My name telephone and email address is now on the Pharmacist files, where he is able to contact me if they are not collected.
This is why I call it back to basic, because it is exactly that.

Sadé Tolani

My Medical eCard Limited
Comment date
24 March 2015
On a grassroot level, the NHS and other health organization's should consider encouraging, educating, empowering individuals to take charge of their medical records.

Individuals can then collate and integrate all their health and medical activities into a simple, easily accessible port like a Medical eCard.

Sadé Tolani
'My Medical eCard'

John Jones

Comment date
22 March 2015
Yet another piece of gem from the Kings Fund, alas no mention of the huge contribution the community pharmacy sector has been, and is ready to make, through a national scheme to ease pressure on the healthcare economy.
The Kings Fund increasingly risks being criticised for remaining introspective and parochial in considering ALL possible options, suggest truly wholistic solutions, and fail to think out of the box. Sorry but this report and references made to 'integrated care' reads the same old-same old, packed with great examples, based on traditional delivery models from the past, embellished with platitudes and soundbites.
Please get in touch and align all the invaluable energies with that of the All Party Pharmacy Group (APPG) of Sir Kevin Barron, Oliver Colvile MP, and Baroness Cumberledge for a taste of how future innovative healthcare delivery models could look like within our health service.

George Coxon

Various inc independent commissioning advisor, care home owner,
Comment date
19 March 2015
I dutifully and eagerly read these latest reports hoping for further endorsement for what I / many see as an obvious and essential set of ideas and recommendations about future health and social care integration. Again having perhaps read the 93 pages too quickly, too naively I feel genuine new vision fell a little short. Social care did get a mention as did care and nursing homes but not quite enough in the way of creative alignment in how alliances can address the increasing needs of a complex older population. Foundation Trusts surely need to look at coalitions with enterprising credible residential care to create a more seemless pathway for frail older people especially the 1:6 or 1:3 over 80/ 90yr olds with dementia. We need new partnerships between residential care and acute trusts- detail of which will of course vary dependent on location,demographics and more critically trusting relationships. In Devon a number of local authority care homes are in the process of closing presenting opportunities for collaboration between acute trusts, commissioners and local residential care providers. It may take vision, risk sharing, trust and cash to see the potential for a health and social care revolution here but perhaps there are signs that we are on the brink. Unless we act soon my fear is health and social care will plunge further into meltdown leaving older people struggling and forlorn.


Member of the public,
Comment date
19 March 2015
I find it so difficult to give a balanced view when faced with such comments in your 'policy implication' heading ie.. 'Acute section leaders should be encouraged take a leadership role'.
Surely, after this length of time of sadly letting patients down, the words should be 'Acute section leaders should be TOLD ....etc '. .Indeed so too should their senior managers or is this word too outrageous today..
Great that there are some real gems of initiatives but this will always be the case as there are some real stars out there determined to do more but they are in the minority it would seem.
More meetings, more conferences, more think tanks, more case studies..........the list of stalling measures that prevent urgent change is endless.

Debbie Sorkin

National Director of Systems Leadership,
The Leadership Centre
Comment date
19 March 2015
The experience we've had of applying system leadership approaches in integration programmes around the country, through the Local Vision initiative and the Integration Pioneers, suggests that you need to give this time - and the perseverance to keep going despite the difficulties - and commitment to a shared vision, so that this isn't about one organisation setting the direction for others to follow but about genuine collaboration. It follows that relationships - honest enough to have the difficult conversations and robust enough to withstand them - are key. It also reinforces Chris Hopson's point at this morning's seminar about having 'air cover' to let new ways of working bed in over a sustained period.

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