What makes a university hospital different?
12 November 2013
Oliver Watson, Senior Policy Officer, AUKUH
Sir David Nicholson received attention at the start of this year for talking about the ‘commanding heights’ of the health economy. This is one of many descriptions that have been used for this type of NHS Trust/Board. Thirty-six NHS Trusts use the words ‘university’ or ‘teaching’ in their title. However, as we’ll see below; there’s more to a university hospital than a name.
What is a university hospital?
University hospitals in the UK are NHS Trusts and Boards with major teaching and research interests.
Nearly a quarter of the acute Trusts in England are AUKUH members. One of the six Trusts in Northern Ireland is an AUKUH member and two of seven Local Health Boards in Wales are members. Together, they act as leaders in the NHS mission of research, teaching and clinical service.
We see the following as the main features of a university hospital:
- major involvement in Research and Development
- significant external funding on site
- major academic presence on site
- commitment to undergraduate and postgraduate teaching of health professionals
- close links with universities and other educational institutions, with formal partnerships that cover research and/or education with one or more universities
- university staff as non-executive directors of the Board
A unique contribution
By delivering specialised clinical services that map on to academic interest and clinical expertise, university hospitals can do more for patients and provide leadership in the NHS. When necessary, they are able to take a leadership role in a local health economy because of having greater capacity, skills and knowledge in particular areas.
University hospitals have the ability and responsibility to create and apply scientific breakthroughs. They are majorly active in crucial health research. In 2011–12, 40 AUKUH members recruited 231,966 patients to 6,993 clinical trials. The average baseline patient recruitment for an AUKUH Trust was 5, 799, the national average was 1,463.
They also make a prominent contribution to the workforce of the future and have a leading role in undergraduate and postgraduate education of NHS staff. Between them they employ approximately 330, 000 staff working in research rich, education focused environments. Data consistently demonstrate that AUKUH Trusts outperform other Trusts in terms of staff experience.
University hospitals are more likely to encounter severe and unusual cases. For example, 19 of the 22 major Trauma centres in England involve AUKUH members. They have the ability to co-locate a wide range of scarce, specialist equipment and expertise required to provide the highest standards of care to patients that have rare and complex conditions.
The intensity of this research, education and service activity forms a virtuous circle, described in the diagram above.
In common with other NHS Trusts, the university hospital’s role is defined by the best interest of patients and the population served. They work in partnership with other health and social care organisations for shared local populations. Through existing and emerging regional forums they spread knowledge and offer development opportunities for staff from neighbouring institutions. Their research leadership frequently involves working with staff and patients in other Trusts, for example in multi-centre clinical trials.
Like the rest of the NHS, university hospitals face the challenges of making huge savings, improving the quality of care and adapting to population change and technological advances. In his January 2013 comments, Sir David argued that they need to be reshaped and reformed in the face of these challenges. In the spotlight of increased scrutiny, can university hospitals make sure their difference is recognised as virtuous rather than distancing?
For more on this subject, please see our publication The Role of the University Hospital.