We must put hospitals at the centre of our communities

The NHS is facing an immense financial challenge. The number of people are increasing, living longer and many with long-term conditions. Despite our resistance, market forces require us to rethink what we are doing.

Alongside the growing fiscal burden, the Keogh review revealed a common theme of geographically and professionally isolated hospitals amongst the 14 Trusts reviewed [1]. This isolation, coupled with Tim Kelsey’s plan of giving public and patients a powerful voice [2], suggest that it is the right time to examine the role of hospitals and public participation. In preparing for the future the NHS must be proactive in promoting health and wellbeing but also reconnect hospitals with local communities; how can we begin to do this?

1. Involve local community groups and third sector organisations: The floor area of the NHS England estate could cover the City of London ten times over [3]. We can allow local groups to use the lecture theatres, workshop spaces and classrooms that are often left empty on weekends and evenings. These spaces can be used for health promotion activities, theatre productions, meetings, exercise classes and learning events.

2. Encourage local providers to deliver services: Despite the popularity of independent local coffee shops our hospitals continue to be dominated by high street chains. Supporting local catering suppliers may give hospitals an opportunity to negotiate a wider variety of healthier food options being made available and better quality meals. Open spaces within Trusts could be be used to support local farmers markets to encourage healthier eating.
3. Connect with local higher education institutions: There are plans to include the smaller district general hospitals within Academic Health Science Networks (AHSNs); it will be interesting to see how much attention they receive from universities against the bigger teaching hospitals. Hospitals can promote innovation through civic ‘hackathons’ connecting patients, clinicians and tech students from local universities and colleges; encourage them to meet at regular events in the hospital mess collaborating to improve local service provision and create a lasting health data community [4].

There are a number of potential work experience and volunteering opportunities that could be made available within hospitals, supporting the economic wellbeing of the community. Hospitals could support local apprenticeship schemes [5] and provide work placements to local children, in areas such as finance to catering, to help with their career prospects.

These are just a few ideas to begin an important conversation. Public and patient participation in hospitals can no longer be limited to episodes of care or positions on committees. Hospitals must become a focal point for the community and not just a place to go when you are sick. The hospital should be redefined as a flexible space that the community own and can adapt to their needs.  The NHS will be overwhelmed by the cost of managing preventable disease if we continue neglect our responsibility as an organisation to promote healthy behaviours. Hospitals cannot be aloof but instead open, engaging and at the centre of community wellbeing.

References

1. Keogh B. Review into the quality of care and treatment provided by 14 hospital trusts in England: overview report (PDF, 1.19Mb). 
2. Board Paper – NHS Commissioning Board http://www.england.nhs.uk/wp-content/uploads/2013/02/item4-280213.pdf
3. NHS Estate: Better together. Nigel Edwards http://opinion.publicfinance.co.uk/2013/07/nhs-estate-better-together/
4. Code for America on Why Civic Hacking Matters http://www.datainnovation.org/2013/08/code-for-america-on-why-civic-hack...
5. NHS Careers www.nhscareers.nhs.uk/working-in-the-nhs/joining-the-nhs/apprenticeships-in-england/

Submitted by Dr Na’eem Ahmed

Dr Na’eem Ahmed (@DrNaeemAhmed) is a junior doctor at the Faculty of Medical Leadership & Management and Clinical Fellow to the NHS National Medical Director Professor Sir Bruce Keogh.