How the system can make the most of the unique role of specialist hospitals

Many of England’s 21 specialist trusts have created international reputations for academic and clinical excellence, and successfully recruit specialists from around the world. They also score higher than other trusts in ratings for performance and patient satisfaction.

But looking beyond the success of individual organisations, how are specialist trusts working more widely across their sustainability and transformation partnership footprint, regionally and nationally to support population health and system transformation? And what more could specialist trusts and others do to spread the innovations they develop more widely across the system?

Across the NHS the system is still poor at rolling out innovations and best practice

As individuals who have led Academic Health Science Networks in England over several years, we were interested to explore the contribution of specialist trusts to the wider health system – in particular their role in spreading best practice. We were also curious as to what other trusts that manage a broader range of services – and work closely with the wider system – might learn from specialist hospitals.

Over the past few months, we have spoken to leaders from 11 specialist trusts as part of a review of the performance and potential of specialist hospitals, and we have been impressed by how some standalone hospitals are leading local work streams, often acting as an “honest broker” in programmes involving many different organisations.

But we could not escape the fact that across the NHS the system is still poor at rolling out innovations and best practice.

Prominent barriers

The barriers are well rehearsed, including the fact that leadership culture (both clinical and managerial) to support innovation and system wide transformation is inconsistent, and that commissioners (both specialised and in clinical commissioning groups), often lack the tools or capability to drive innovation in their commissioning and contracting work.

There’s also a lack of effective and systematic innovation architecture available to support innovations that have the potential to make large scale impact, and financial incentives are not always geared towards rewarding the innovators and can act as a disincentive to adoption.

We identified the potential to make more of the unique role of specialist hospitals across the system at three levels.

First, specialist hospitals themselves could do more to drive best practice and better outcomes using global comparisons. While many specialist trusts have developed stellar international networks and impressive expertise and standing, we didn’t hear of many systematic ways of measuring outcomes in a global context or using international comparisons to drive best practice and innovation. Specialised commissioners should consider supporting the international benchmarking of specialist trusts, using some of the service outcome standards.

Second, there is more that could be done at a regional level, both by linking into regional agencies such as AHSNs and national organisations such as the National Institute for Health Research, as well as appropriate commercial partners. Many of the specialist hospitals that are successfully innovating employ a senior person to lead on innovation and to link to these agencies. We propose that guidance on a best practice approach to service innovation could be developed by the AHSN Network in collaboration with specialised commissioners, with expert advice available to all trusts to help them fast track service innovations.

Third, national bodies could do more to make the most of the unique role of specialist hospitals. For example, NHS England should consider how more specialist hospitals could provide a supportive population health management role in system transformation.

We found an appetite among specialist hospitals to share expertise and undertake leadership roles across systems and networks

There’s also work to be done to fill a communications and awareness gap about what is available in terms of support for innovation and adoption. With lots of new policies in this area, many specialist hospitals are unaware of the national policies, levers and funding streams that might encourage faster adoption and spread of innovations.

In the UK, we don’t have the systematic translational pipeline we see in parts of the US. As a nation we have a strong track record in discovery science but are less strong at commercialisation, lacking an appropriate level of investment and approach to commercialisation of new developments.

There is no room for complacency at a time of considerable change and challenge, with the rapid approach of Brexit bringing economic uncertainty and workforce issues, and specialist centres from other countries opening their doors in England.

We found an appetite among specialist hospitals to share expertise and undertake leadership roles across systems and networks. Looking through a system wide lens it is clear there is potential to make more of their unique role.