It’s tempting to assume that surviving the economic downturn and implementation of the coalition’s health policy is the key to future provider organisational survival. Not so. It is strategy that will be the defining characteristic of provider organisations during the next decade.

Yes, everyone will be beavering away tackling their cost base and ensuring that bottom lines are delivered but all this will come to nought unless it’s undertaken against the backdrop of a clear strategic plan.  

Although all providers will have to undergo change, the strongest providers will be university trusts. I don’t mean all providers with the epithet ‘university’ or ‘teaching’ in their title but the full-blown tertiary centres with interlinked on-site specialties that collectively can provide safe and good quality specialist services. Although they are strong organisations, they are not wholly safe because to secure strategic survival many are already thinking about establishing mutually beneficial network-based business relationships with surrounding secondary care providers.

Secondary care general hospitals will have to undergo change because of the inexorable trends in the development and delivery of medicine. It is this that results in more change than anything else including government policy. Add the consumer drive for services to be delivered closer to home and district general hospitals will have their strategic development skills tested.

It is however the providers positioned between tertiary centres and district general hospitals that will have the greatest strategic challenge. These are the hospitals that provide a significant secondary care service but with the addition of one or two specialist services, perhaps cardiac or vascular surgery or a specialist medical service. These specialist services are unlikely to be sustainable for quality and safety reasons.  

But of course the challenges facing these ‘quasi-tertiary’ centres are not new. There are many of these hospitals around the country, often in urban locations close to their more powerful full-blown tertiary cousins, and they have faced this strategic conundrum for many years.  Can they develop their specialist base (unlikely) or do they accept that their role is essentially that of secondary care provider? These questions are not easy but now more than ever they need answering.

Whether we like it or not the trend in medicine is towards centralisation of specialist inpatient facilities to drive up outcomes and expertise. And we want to be safe in the knowledge that if something goes wrong a full clinical infrastructure is immediately available to help.

There will be boards and chief executives who recognise the need for strategic action as well as delivering the bottom line, perhaps wisely already preparing to make substantial change, developing mutually beneficial inter-organisational relationships or acknowledging the need to strategically tack away over the next few years. These are the organisations that will do well. Those providers that ignore strategy and focus solely on short-term delivery will end up in a cul-de-sac with no way out.