University of Birmingham

Progress and Reports

 

Factors affecting the changing role of GP clinicians in community hospitals: a qualitative interview study in England

 

Dr David Seamark with the research team has published an article on the changing role of GPs in community hospitals. The variety of clinical arrangements are described in the study. The study describes the role of GPs as a driving force in the development of community hospitals, and their experience as typically positive. However multiple factors have led to many GPs losing their involvement in their local hospital. The study concludes that a focussed strategy is needed if GPs are to remain engaged in community hospital work. 

To read more 

 

 

The First Major Study on Community Hospitals in England Provides Evidence on their Community Value 

NIHR 22nd January 2019  Read the report here

 

 

The CHA welcomes this study which brings new knowledge on the value of Community Hospitals to patients and communities.  The CHA is pleased to be a partner with the University of Birmingham on this study, which provides new evidence on the role of Community Hospitals as contributing to integrated care systems by offering a community-based service that is trusted and supported by their local communities.

 

The CHA has been delighted to be a partner in this important research study that has focused on the profile, characteristics, patient experience and community value of community hospitals (1).   The study is one of three interlinked studies in a Community Hospitals Programme funded by the NIHR.  One of the studies identifies transferable learning from international developments (2) and another considers models to optimise community hospital care (3).  These are all areas that have been under-researched in the past.

 

The research team in Birmingham identified 296 community hospitals in England and profiled them for their characteristics and features.  There is not a nationally agreed definition of a community hospital, so the team focused on characteristics and features. The study identified community hospitals as small, local hospitals that were predominantly rural, providing a range of services on a spectrum from primary to acute care orientation.   Nine community hospital were case study sites and the CHA is grateful to the hospitals and in particular the patients, carers, staff, managers, volunteers and members of the community from these hospitals who agreed to participate in interviews and focus groups. 

 

The key findings of the study describe community hospitals as providing integrated services in a model of embedded relational care, offering reassurance.

  • Integration: “Community hospitals offer local integrated intermediate generalist care within one accessible location.”
  • Embedded Relational Care: “It is an embedded and relational model of care which stems from the local history, geography and social relationships of the community.”
  • Reassurance: “Community hospitals offer reassurance with a sense of community ownership.”

The CHA supports these findings which, the CHA believes, encapsulate the essence of community hospitals.  In particular, the CHA has observed that local communities signify ownership by referring to “our hospital,” and express trust, loyalty and pride in their hospital.  A quote in the report summarises this: “This is our local hospital and we are proud of that.”  Another refers to the hospital as “a local treasure.”

 

 

 

 

The findings of the study with regard to patient and carer experience was overwhelmingly positive.  This concurs with the CHA experience in respect of our work in community hospitals, our analysis of publications, our Innovations and Best Practice programme, and our reports from members.  For the first time, there is evidence of positive experiences that will now be in the public domain. One patient described it as “it feels like home” and others talk of the convenience, the personal care and the overall support.  One patient said it was “a lifeline.”

 

The study included an analysis of the community contribution to their local hospital, with respect to financial support (an average of £45k p.a.) and number of volunteers (an average of 24 per hospital).  The study found that members of the community also contributed through providing services and support, and also by promoting the hospital and having a voice.  Although the study found a trend of decreasing financial contributions, the CHA believe it is important to recognise the many ways in which local communities support their community hospital.  In particular the role of volunteers, which is recognised as significant in the NHS Long Term Plan (4).

 

The study identifies many positive aspects of community hospitals and services, although cautions that recent changes have the potential to undermine these positive experiences and values. 

 

The CHA endorses the findings of the report which show the role that community hospitals have to play that contribute to national policy, namely by providing “care closer to home” and by providing integrated care.  This finding supports other studies in the programme (2).

 

Integrated working in Community Hospitals is in keeping with the Integrated Care Systems (ICS) set out in the NHS Long Term Plan (4).   Community hospital services support the planned increase in out of hospital care, and already contribute to breaking down the barriers between primary and community services (4).

 

All the studies draw attention to the wide variation in community hospitals and services (1,2,3).  The CHA would welcome further research into the range of community hospitals and services and new models of care.  Important area for future research include the impact of community hospital services in rural areas beyond healthcare and innovative ways of working with communities.

 

The CHA views the study and the report as an important contribution to the planning and management of health care services, offering new knowledge and evidence on the role that community hospitals have to play across the whole health and care system, and also within their communities.  It is hoped that the evidence will be of value to all concerned with community hospitals, and in particular commissioners, providers, patients and their communities.

 

 

Dr Helen Tucker, President of CHA

On behalf of the Directors and Committee   January 2019

 

 

References

 

  1. Davidson D, Ellis Paine A, Glasby J, Williams I, Tucker H, Crilly T, et al . Analysis of the profile, characteristics, patient experience and community value of community hospitals: a multimethod study. Health Serv Deliv Res 2019;(1)   Report at NIHR website: https://www.journalslibrary.nihr.ac.uk/hsdr/hsdr07010#/abstract
  2. Pitchforth E, Nolte E, Corbett J, Miani C, Winpenny E, van Teijlingen E, et al.Community hospitals and their services in the NHS: identifying transferable learning from international developments - scoping review, systematic review, country reports and case studies. Health Serv Deliv Res 2017;5(19)
  3. Young, J., Godfrey, M., Teale, E., Hulme, C., Smith, A., Bucknell, J., Enderby.P., Gladman, J., Tucker, H. et al. A Study to understand and Optimise Community Hospital Care in the NHS: the Models of Community Hospital Activity (MoCHA) Study Health Serv Deliv Res 2019 (publication pending)
  4. NHS England The NHS Long Term Plan  January 2019

 

 

Professor Jon Glasby speaking on Community Hospitals 

 

Professor Jon Glasby presents the key findings of the report which shows that community hospitals are valued and trusted by patients and communities.   Jon Glasby talks of decisions on health provision being driven by "value for money."  Jon Glasby asks whether we should not focus as much as the "value" as the "money" - and have a broader notion of what matters to local people when we are deciding about the future of local services. 

 

Link for the video 

 

 

 

BJGP Conference - Talk by Dr David Seamark

 

As a member of the Birmingham Project Team, Dr David Seamark delivered a talk on the reducing number of GPs involved in community hospitals, as identified in the study. He spoke of the many factors that had led to this change, and illustrated these factors with quotes from GPs and Trust Doctors who had been interviewed.   The talk stimulated a number of questions which were answered by David and Helen Tucker. The talk prompted discussion beyond the session.  Dr Roger Jones, Editor of the BJGP, said that it was an issue "close to his heart," having been Secretary of the Community Hospitals Association (previously the Association of GP Hospitals).  David Seamark is drafting an article on this for the BJGP with contributions from the team. 

 

Hosts Helen Stokes Lampard and Roger Jones, and keynotes Ben Goldacre, Pali Hungin, Richard Hobbs

For more information on the BJGP conference, please follow the link

 

 

Community Hospitals in England (download excel spreadsheet here)

 

In 2014, the research team at the University of Birmingham undertook a mapping exercise in England, to help identify the overall number of community hospitals, their location and their characteristics (services and key activities). Data used was provided by the English Health and Social Care Information Centre (HSCIC) for 2012/13 which gave a list of all hospitals in England. Community hospitals were identified using a ‘site of treatment code’ (medical speciality) which, combined with size (number of beds), differentiated them from other forms of hospitals. In 2015, the HSCIC list of hospitals was reconciled and with other datasets from the Community Hospitals Association (CHA), the Patient-Led Assessments of the Care Environment (PLACE) and NHS Estates Returns Information Collection(ERIC).  The final list shows known community hospitals with beds as of September 2015, but services and activities relate to 2012/13 levels.

 

The 3 pages on the excel spreadsheet are:

  1. Final list by region;
  2. Summary - A summary of hospitals by speciality classification and
  3. Named Moved List - which gives a list of all hospitals, and those moved into the list of community hospitals.

The research team acknowledge the rapid changes in community hospitals over the period of the study. Changes include changes in services, ownership and provider organisations.  A number of community hospitals have since closed inpatient wards, or closed altogether.  The CHA regularly updates the list, and makes this accessible on the website through googlemaps.

 

 

 

University of Birmingham Viewpoint  "Community hospitals - discovering a new model of care?"  

 

Dr Helen Tucker was invited by the University of Birmingham to write a blog, setting out her views on community hospitals and describe how they are changing. The article compares the origins and history of community hospitals to their current and potential role. The article describes major changes in services and providers in community hospitals.  She suggests that traditional features of the community hospital model fit well with the aspirations of the NHS and "new models of care." To read the article please follow this link.

Viewpoint was written by Dr Helen Tucker, President of the Community Hospitals Association. 

 

 

 

Draft Report on Community Hospitals Submitted to NIHR

The team of researchers at the University of Birmingham have just completed the first draft of their report on community hospitals, and this has now been submitted to the NIHR. The team has been led by Professor Jon Glasby, with the project manager, Deborah Davidson. When published, this will make new contributions to the knowledge on community hospitals.

Community Hospitals Association Conference Presentations

 

2017

 

It's Personal - Understanding Patient Experiences of Community Hospitals

 

Deborah Davidson, Angela Ellis-Paine and Nick Le Mesurier gave a presentation of initial findings of the interviews with patients, carers, staff volunteers and community in 9 community hospitals.  This was given at the 2017 CHA conference and is available to download here

 

 

Professor Jon Glasby recorded a talk on the role of community hospitals which is available here.

 

In this talk, Jon Glasby says that community hospitals have a key role to play, and says that if community hospitals don't have the answer then in one sense, who does. Jon Glasby talks of the challenging policy context, but also says that this is an opportunity to think through:

What role do we play

What are we good at

What do we value

How do we mainstream that

How can we be proactive and be on the front foot

 

The talk is a valuable contribution to the discussions at the conference on the strategic role of community hospitals, and the future of this model of service.

 

 

2016

 

Deborah Davidson and Angela Ellis-Paine gave a presentation at the CHA conference in May 2016 which provided an update on the progress of the study. They also ran a workshop for delegates to help define community hospitals, identify characteristics, and discuss types of community hospitals.

 

Newsletter 

 

The team publishes a regular newsletter setting out progress on the study. 

A University of Birmingham HSMC progress report

 

 

Charitable Support for Community Hospitals

 

Daiga Kamerāde and John Mohan from the Third Sector Research Centre at University of Birmingham analysed the financial support received by community hospitals.  They concluded that"Community hospitals receive a substantial financial support from their communities; however, this support has been declining is sensitive to macroeconomic changes - while it is generous during economic growth, it can substantially decline during economic recessions."

"Mapping community-based financial charitable support for community hospitals in England and Wales 1: first findings."

 

 

Viewpoint on Community Hospitals 

 

The University of Birmingham offers an opportunity for opinions to be shared through a"viewpoint" area on their website. 

"Local people clearly have confidence in their local hospital service, and when creating community capacity to enable more people to be treated outside of acute hospitals, this would seem to be a strong basis to build on."  

The Essence of Community Hospitals  Dr Helen Tucker

 

 

Briefing for Parliamentary Debate

 

A briefing paper was prepared by Helen Tucker to inform a debate in the House of Commons on the future of community hospitals, and this was shared across the Health Services Management Cantre of the University of Birmingham.

"The way that local people demonstrate their trust in their community hospital and the way they value the service may be viewed as a credit to the local NHS and a significant achievement. Ideally this should indicate that community hospitals are a positive platform for community-based services, and can serve the role as a hub for integrated health and social care."  

Parliamentary Debate on Community Hospitals 

 

 

Top