Intended for healthcare professionals


Small hospitals could help to bolster community services, says NHS chief

BMJ 2014; 348 doi: (Published 30 May 2014) Cite this as: BMJ 2014;348:g3662
  1. Zosia Kmietowicz
  1. 1The BMJ

The head of the NHS in England has signalled that small local hospitals should become the focus of expanded and improved services in the community to allow elderly patients to be treated locally.

Simon Stevens, who took up the post of chief executive of the NHS in England in April, said that small hospitals were vital in meeting the needs of an ageing population and would provide focus for community services that had become “too complicated and too fragmented.”

The current lack of coherent local services meant that too many patients were being denied “dignity and compassion,” he said in an interview with the Daily Telegraph.1 Stevens said that countries such as Sweden, the Netherlands, and the United States had pioneered ways of strengthening community care around small hospitals and that Britain could learn from this.

Stevens is due to make a speech on 4 June at the annual meeting of the NHS Confederation, at which he is expected to outline new models for community services based around small hospitals to meet the needs of elderly patients. These smaller hospitals could take over the running of some general practice services and establish closer working between hospital consultants and GPs.

In a separate interview with the Health Service Journal Stevens hinted that closing hospitals that were struggling to gain foundation status because of financial difficulties was not necessarily the way forward.2 He told the journal, “Rather than talking about failing institutions, perhaps we need to talk about pressured health economies and community-wide alternative solutions or models, rather than just singling out the hospitals. In some cases it’s going to mean we’re going to have to completely reinvent what we mean by a hospital, by a local hospital.

“We’re going to have to say that the division between what consultants do in hospitals [and] what GPs do in a community setting is going to be dissolved.”

He added that in some areas the traditional split between commissioner and provider may not be appropriate and that it may be better to have one provider running “combined hospital, primary care, [and] community services.” He said, “The status quo is clearly not working in a number of parts of the country. At that point you either say it’s time to do something differently or people are just faced with the more typical response, which is that services have got to close.”

However, Stevens noted that further structural reorganisation of the NHS would be “a distraction.” He said that the single most pressing matter for the NHS was how best to support older people.

“You cannot have a modern health service that is not treating older patients with dignity and compassion, supporting them at home and ensuring targeted prevention [of ill health],” he told the Daily Telegraph. Too frequently vulnerable patients were being admitted to hospital because the basic care that they needed at home was not available, resulting in falls and other incidents that could have been avoided. The arrangements for care in the community needed to be simpler and more robust, said Stevens.

“There is a big opportunity to reorganise [care outside hospitals] so it meets the needs of those at home. At the moment it is too complicated and too fragmented. If you were starting from scratch you would not design community services like that,” he said.


Cite this as: BMJ 2014;348:g3662