South East Clinical Senate. The Clinical Co-Dependencies of Acute Hospital Services – January 2024

The first edition of this document was produced in response to a major focus on the future role of acute hospitals. That focus has not diminished over the intervening time period and the acceleration of new and different ways of working driven by the COVID-19 pandemic has prompted a fresh look at what services we provide from acute hospitals, how we provide those services, and how they might be provided differently in the future. Acute hospitals continue to need to better integrate their function with the local community and primary care services, deliver high quality, safe and accessible inpatient care to their populations with a wide range of general and specialist needs, whilst also finding novel and innovative solutions to the growing backlog of elective care. This in itself has also focussed interest on separating and centralising certain aspects of care away from what we traditionally think of as acute care (where a patient receives active, short-term treatment for a condition). There remains uncertainty as to the evidence and need for centralisation, the resultant impact, and the unintended consequences. As we attempt to address these, at the same time it continues to be the case that pre-existing inequalities persist with data showing that between 2019 and 2020, the fall in completed treatment pathways was 35% higher in the most deprived areas of England, compared with the least deprived areas, with a similar picture for cancer referrals.