Community hospitals and their services in the NHS: identifying transferable learning from international developments - scoping review, systematic review, country reports and case studies

Background: The notion of a community hospital in England is evolving from the traditional model of a local hospital staffed by general practitioners and nurses and serving mainly rural populations. Along with the diversification of models, there is a renewed policy interest in community hospitals and their potential to deliver integrated care. However, there is a need to better understand the role of different models of community hospitals within the wider health economy and an opportunity to learn from experiences of other countries to inform this potential. Objectives This study sought to (1) define the nature and scope of service provision models that fit under the umbrella term ‘community hospital’ in the UK and other high-income countries, (2) analyse evidence of their effectiveness and efficiency, (3) explore the wider role and impact of community engagement in community hospitals, (4) understand how models in other countries operate and asses their role within the wider health-care system, and (5) identify the potential for community hospitals to perform an integrative role in the delivery of health and social care. Methods A multimethod study including a scoping review of community hospital models, a linked systematic review of their effectiveness and efficiency, an analysis of experiences in Australia, Finland, Italy, Norway and Scotland, and case studies of four community hospitals in Finland, Italy and Scotland. Results The evidence reviews found that community hospitals provide a diverse range of services, spanning primary, secondary and long-term care in geographical and health system contexts. They can offer an effective and efficient alternative to acute hospitals. Patient experience was frequently reported to be better at community hospitals, and the cost-effectiveness of some models was found to be similar to that of general hospitals, although evidence was limited. Evidence from other countries showed that community hospitals provide a wide spectrum of health services that lie on a continuum between serving a ‘geographic purpose’ and having a specific population focus, mainly older people. Structures continue to evolve as countries embark on major reforms to integrate health and social care. Case studies highlighted that it is important to consider local and national contexts when looking at how to transfer models across settings, how to overcome barriers to integration beyond location and how the community should be best represented. Limitations The use of a restricted definition may have excluded some relevant community hospital models, and the small number of countries and case studies included for comparison may limit the transferability of findings for England. Although this research provides detailed insights into community hospitals in five countries, it was not in its scope to include the perspective of patients in any depth. Conclusions At a time when emphasis is being placed on integrated and community-based care, community hospitals have the potential to assume a more strategic role in health-care delivery locally, providing care closer to people’s homes. There is a need for more research into the effectiveness and cost-effectiveness of community hospitals, the role of the community and optimal staff profile(s). Funding: The National Institute for Health Research Health Services and Delivery Research programme

Evaluation of The Atlantic Philanthropies Migration Programme

This is the final report of an independent evaluation of Atlantic's Migration Programme that ran from 2004 until 2014. The Programme issued grants to organisations helping migrants to gain access to justice and services. The report presents findings about the impacts the Programme had on law, policy and practice in Ireland.The evaluation identified a number of promising practices for civil society organisations advocating for policy and practice change, as well as for funders supporting such organisations. A set of case studies showcase these promising practices, focusing on using legal and community-based advocacy, developing and harnessing information to inform policy and practice, building links to Brussels to influence national and European migration policy and communicating advocacy messages about migration

Factors That Encourage or Discourage Doctors from Acting in Accordance with Good Practice

Scraggs E, Bereton L, Newbould J, et al. Factors That Encourage or Discourage Doctors from Acting in Accordance with Good Practice. London: General Medical Council; 2012

Regulating quality and safety of health and social care: international experiences

This report is concerned with ‘standards of quality and safety’ within health and social care systems. Care standards are intended to support efforts in maintaining and improving the quality of care; they have been developed across countries, although the ways in which they are implemented and applied differs between nations. Taking a range of six countries, we review the regulatory mechanisms that have been implemented to ensure that essential standards of care are applied and are being adhered to, and consider the range of policy instruments used to encourage and ensure continuous quality improvement. We report on Australia, England, Finland, Germany, the Netherlands and the USA, with the information presented reflecting the regulatory systems as of 1 August 2013.This report was commisioned by UK Department of Healt

Regulating quality and safety of health and social care: international experiences

This report is concerned with 'standards of quality and safety' within health and social care systems. Care standards are intended to support efforts in maintaining and improving the quality of care; they have been developed across countries, although the ways in which they are implemented and applied differs between nations. Taking a range of six countries, we review the regulatory mechanisms that have been implemented to ensure that essential standards of care are applied and are being adhered to, and consider the range of policy instruments used to encourage and ensure continuous quality improvement. We report on Australia, England, Finland, Germany, the Netherlands and the USA. The report is intended to inform policy thinking for the Department of Health and others in developing the regulation of safety and quality of health and social care in England. It was prepared as part of the project 'An "On-call" Facility for International Healthcare Comparisons' funded by the Department of Health in England through its Policy Research Programme

Higher education entrance qualifications and exams in Europe: a comparison

The study analyses admission systems to higher education across ten countries, covering some countries of the European Union (France, Germany, Italy, Slovenia, Sweden and the United Kingdom), a candidate country (Turkey) as well as commonly used international comparators (Australia, Japan and the US). These countries are compared on three axes: the equity of admissions, their quality and their ability to encourage students’ mobility. On this basis, recommendations are provided with regard to admission to higher education in Europe

Financing and Reimbursement

Differences in financing mechanisms and sources and in the allocation and flows of funding are frequently cited as a major barrier for the implementation of more integrated approaches to service delivery. In response, countries have experimented with different financial instruments and mechanisms, such as setting aside dedicated resources to support the development and implementation of innovative care models, introducing new forms of paying providers in order to incentivise coordination and integration, shifting the responsibility for funding of particular components of service delivery between funding agencies, or introducing pooled budgets to integrate health and social care. This chapter provides an overview of the different ways countries have sought to change financing and payment mechanisms at different levels in order to enable better coordination among providers in the delivery of health services and between health and social care and thus support integration