The Clinical Co-dependencies of Acute Hospital Services: A Clinical Senate Review

Given the current intense national focus on the future shape and function of hospitals, stakeholders in health care systems have to consider the most appropriate configuration of their hospitals so that their clinical services are adequately supported by other specialties, are fit for purpose, sustainable, accessible and deliver the highest possible quality of care. The clinical relationships and dependencies of hospital-based services on each other is key, but the evidence base to guide an understanding of these dependencies is uncertain.

On this basis, the seven Sussex CCGs (through their Collaborative) sought from the South East Clinical Senate (SECS) generic, evidence-supported clinical advice on the necessary relationships between acute hospital services, to inform their future local discussions and planning. The remit of the review was to provide generic advice, not region or locality-specific, and to identify evidence where it exists, or clinical consensus where it did not, to describe what services needed to be provided in the same hospital (either based there, or inreaching), and what could be provided on a networked basis. A clinical reference group was established, a literature review undertaken, and a clinical senate summit convened, and SECS worked closely with the four strategic clinical networks in the region.

The dependencies of eleven major acute hospital services were reviewed: A&E (emergency medicine), the acute medical take, the acute surgical take, critical care (ITU), trauma, vascular surgery, cardiac, stroke, renal, consultant-led obstetric services and acute general paediatrics. The clinical dependencies of these services on a wide range of acute hospital based services was reviewed, and a four-level system for describing the strength of the dependencies was developed, and a co-dependency grid constructed.

From the completed grid, it was possible to identify core groupings of services required to be based on the same hospital site, and delineate what an emergency hospital should provide on-site as a minimum, and the needs of the more specialist acute services reviewed.

The report contains important reviews of addition broad themes that must be taken account of in considering service change. These include the public and patient perspective, ambulance service issues and opportunities, workforce issues, the teaching, training and research issue, the provision of liaison psychiatry support to acute hospitals, and the potential for telemedicine to enable better networking or services.

This report is intended to be a useful clinical reference point to commissioners, providers and clinicians in the future planning of their acute hospital services.