University of Birmingham

 Webinar - Efficiency of Community Hospitals


Questions of efficiency: Are community hospitals an effective and efficient way to deliver intermediate care and what might this mean for their future role?    

Chair: Professor Jon Glasby University of Birmingham      Speakers: Professor Claire Hulme, University of Exeter and Dr Helen Tucker, CHA 


Read more:  Scientific summary and Plain English summary   NIHR Final Report - download here 

"Measuring and optimising the efficiency of community hospital inpatient care for older people" 

The MoCHA mixed-methods study - Health Services and Delivery Research.    Young JHulme CSmith ABuckell JGodfrey MHolditch CGrantham JTucker HEnderby PGladman JTeale E & Thiebaud J.


The study found that the efficiency of community hospital wards is comparable with acute hospitals and that modifiable performance factors might lead to potential efficiency savings.   This is an important piece of work, and adds to the evidence base on the performance and contribution of community hospitals. 


To download the full report on the NIHR website please click here 

To download the summary reports please click on the options below:


Plain English Summary

Scientific Summary



Mocha Toolkit for In-Patient Care in Community Hospitals


The Mocha toolkit has been developed to assist staff, managers and commissioners to understand and optimise community hospital inpatient performance.  Mocha is the project name for the study looking at models of community hospital activity. 


The toolkit contains an efficiency score calculator which is an interactive tool that enables the input of key factors that impact on performance. These can be calibrated by users to test out the impact of change.  The toolkit also includes patient "vignettes" that illustrate in each patient inpatient episode factors affecting quality and efficiency.  It is hoped that these will help to enhance understanding of managing the complexity of inpatient care. The CHA will be adding further vignettes to the toolkit, to illustrate how the variables impact on patient care and ward management.  


The Mocha toolkit has been developed by NHS Benchmarking Network, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust and the Community Hospitals Association.   Please email us your comments and contributions here


Please access the Toolkit here




Presentation to the Community Hospitals Conference 2017


Professor John Young from the University of Leeds and Jessica Grantham from the NHS Benchmarking Network gave a presentation on their progress in the Mocha study in answering two research question.


- What is the current relative performance of community hospital ward care for older people?

- What are the key characteristics to optimise performance?


 They also described their pilot toolkit for assessing optimal performance on inpatient wards. 


To download the presentation, please follow the link.






Key Findings from Studies Carried out by the Leeds Research Team



"The results of previous and newly emerging research investigating community hospital wards provide confidence that it is an effective and efficient model of care for older people recovering from illness."

Professor John Young



"Older people's wards in community hospitals are as cost efficient as those in larger, general hospitals"

Buckell et al 2017 (publication pending)

"Also, from a previous multi-centre randomised controlled trial, it has been shown that the independence outcomes at six months for patients randomised to community hospital ward care were superior to larger general hospitals. 

Green et al 2005

"Community Hospitals are shown to meet the requirements of evidence-based care and cost-effectiveness in the multi-centre RCT. The other pillar of policy requires it to achieve patient approval. This it also does."  

Small et al 2006



Understanding the Models of Community Hospital Rehabilitation Activity (MOCHA); a mixed-methods study


To understand the variation in performance between community hospitals, our objectives are: to measure the relative performance (cost efficiency) of rehabilitation services in community hospitals; to identify the characteristics of community hospital rehabilitation that optimise performance; to investigate the current impact of community hospital inpatient rehabilitation for older people on secondary care and the potential impact if community hospital rehabilitation was optimised to best practice nationally; to examine the relationship between the configuration of intermediate care and secondary care bed use; and to develop toolkits for commissioners and community hospital providers to optimise performance.


John Gladman, John Young, Andrew Smith, Sattis Saggu, Mary Godfrey, Pam Enderby, Elizabeth Teale, Roberto Longo, Brenda Gannon, Claire Holditch, Heather Eardley Helen Tucker


To read the article, please follow the link  




Cost Structure and Efficiency in Community Hospitals in the NHS in England


John Buckell and the team have published a Working Paper Number: WP16_01.   This paper identifies the characteristics of community hospital in-patient care for older people that optimise performance.  A series of health economics models were used to predict efficiency within a sample of Community Hospitals. This working paper provides evidence to support the effect of variables on efficiency within the community hospital setting, including length of stay, percentage bed occupancy, input prices and staff mix.  The modelling  used in the paper suggests that community hospitals could reduce operating costs in the provision of service on older people‚Äôs wards by 17% if performance was in line with best practice.



Community hospital research to reveal impact of nurse staffing levels


An article featuring the study was published in the Nursing Times     In the article, Professor Young stressed that the research would not just be focussing on the cost, but would show how those best performing hospitals were able to provide quality services.



National Survey

The study team have undertaken a national survey of all community hospitals across England, Wales, Scotland and Northern Ireland which was designed to augment data from the NHS Benchmarking Network datasets. We would like to thank all hospitals that returned the questionnaire.



If you would like further information on the study or the national survey please do not hesitate to contact Satti Saggu on