Publication July 2021
Davidson, D., Williams, I., Glasby J. (2021) “Localism and Intimacy, and… Other Rather Imponderable Reasons of That Sort”: A Qualitative Study of Patient Experience in Community Hospitals in England. A pre-print.
June 2021 DOI: 10.21203/rs.3.rs-583651/v1
The study suggests the need to weigh 4 dimensions of patient experience (functional, relational, social and psychological) when assessing the role and contribution of community hospitals. When considered together, the authors conclude that these four elements point to community hospitals as providing a primarily embedded and relational, rather than transactional, model of care. Read more
Webinar - Understanding Value
Understanding value: How are community hospitals valued by their communities, and beyond, and what might this mean for their future role?
Chair: Professor Jon Glasby - University of Birmingham Speakers: Deborah Davidson and Dr Angela Ellis Paine - University of Birmingham
Communities Supporting Community Hospitals - Article in BMJ Open
An article has just been published by Angela Ellis Paine and the team from the University of Birmingham on the support of communities for their local healthcare and in particular their community hospitals.
The team explores the support that communities gave to their community hospitals which they categorise as human, financial practical and intellectual resources. The authors state that "Communities provide valuable supplementary resources to the National Health Service, enhancing community hospital services, patient experience, staff morale and volunteer well-being." The article concludes that "Communities can be a significant resource for healthcare services, in ways which can enhance patient experience and service quality."
The authors are concerned about how this support may be continued in the current NHS. "Harnessing that resource, however, is not straight forward and there is a perception that it might be becoming more difficult, questioning the extent to which it can be considered sustainable or ‘renewable."
"Communities as ‘renewable energy’ for healthcare services? A multimethods study into the form, scale and role of voluntary support for community hospitals in England" Angela Ellis Paine, Daiga Kamerade, John Mohan, Deborah Davidson October 2019 BMJ Open 9(10):e030243
Latest Summary Research Study on Community Hospitals and Community Value
A useful booklet of an illustrated scientific summary of the study by the University of Birmingham with the CHA can be downloaded here. Please share widely.
A link to the University of Birmingham webpage on the study can be found here
Local Launches of the study are being held across the country. Participants and those concerned and involved with community hospital case study sites are being invited to seminars where the report is presented and discussed. The sessions are also used to encourage debate on the current and future role of community hospitals locally and nationally. Lively sessions have already been held in Sussex and Devon. The CHA is pleased to be involved in these seminars, and to contribute the national perspective. Local reports on key issues of common interest will be shared on the CHA website.
Summary of Research Study on "Value and Community Hospitals"
The CHA has summarised the study on one page as a reference guide. Please contact Dr Helen Tucker at the CHA for more information here.
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.
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
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.
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
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.
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:
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.
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.
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.
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.
The team publishes a regular newsletter setting out progress on the study.
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."
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."
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."