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Monitor is to examine the challenges that smaller district general hospitals face in delivering high quality, sustainable care to patients, and how they are responding.

The health sector regulator wants to hear from patients, providers, commissioners, health care professionals and any other parties with an interest in providing acute care as it looks at the challenges facing these providers.

For the purpose of this study, Monitor is primarily looking at non-specialist providers that operate at least one acute general hospital, with an annual income of £300 million or less, although it will be asking for help from all sizes of provider to draw comparisons.

Monitor is seeking evidence on:

• whether smaller non-specialist acute providers are facing particular difficulties in delivering high quality, sustainable services;
• factors that may affect these providers’ ability to deliver high quality services to patients or to respond to issues;
• the opportunities they have to address potential challenges and to demonstrate innovative, high quality service delivery.

Importantly, we are open to evidence that factors other than scale may pose challenges to providers.

There are just over 140 non-specialist acute trusts in England, which together receive a total income in the region of £50 billion per year for all their services. Around half of these trusts have income of less than £300 million.

David Bennett, Chief Executive at Monitor, said: “We have an important job to do in making sure that the whole sector works in the best interests of patients and understanding the pressures on small hospitals is an important part of that job.

“Smaller acute providers are an integral part of the NHS and we want to know more about the pressures they face and whether there is a size at which small hospitals become unviable.”

This is an exploratory research project, we are not pre-disposed to any particular outcome or solution. The research is not intended to be used for analysing the performance of individual trusts (although Monitor could use this information to meet our broader regulatory role should it appear appropriate to do so).

Monitor is working with the NHS Trust Development Authority on this research project, as well as other organisations across the health sector.

David Flory CBE, Chief Executive of the NHS Trust Development Authority, said: “NHS providers will face unprecedented challenges over the next few years and it is really important that we strive to get a better understanding of any barriers they face to achieving high quality, sustainable care. “This important piece of work will help to contribute to our understanding of the challenges facing NHS providers so that we can work to create the conditions for them to push on and deliver improvements in care for their patients.”

Terence Stephenson, Chairman at The Academy of Medical Royal Colleges, said: “It is important to understand the challenges faced in delivery of high quality, sustainable health care and in doing so it is essential that clinical expertise informs the discussion of potential changes to service provision and that clinical standards and safety remain the primary consideration. We are therefore keen to support this work by Monitor in the interest of our shared commitment to delivering on-going high quality care for patients.”

Notes

• For further information please contact the press office on 02037470800 or email press.office@monitor.gov.uk
• The call for evidence can be found here
• Monitor is the sector regulator of NHS-funded health care services. Under the Health and Social Care Act 2012 its main duty is to protect and promote the interests of people who use them. Information about Monitor’s role can be found here
• Submissions can be sent to smalleracutes@monitor.gov.uk