"The imminent demise of the hospital has been a recurring theme for decades, yet hospitals are still thriving. There are, however, some major challenges that hospitals will have to face in coming years. While many of these stem from developments in medicine, there are also significant pressures from changes in society.

Nigel Edwards, in the foreword to the Confederation's report The future of acute care (510Kb PDF)

The launch of Our health, our care, our say (466Kb PDF), on the future of community health and social care services, begs some important questions about what needs to be inside a hospital. Over the course of the past century, the UK's hospitals have accumulated control over many services that are typically found outside hospitals in other countries.

'New' visions for hospitals have tended to be quite rigidly constrained by historical or professional divisions that have no relationship with what patients actually require. In particular, it is time to question the apparently inexorable trend towards centralisation and specialisation, if there is to be any chance of giving the reality to the rhetoric about shifting services closer to home."

Some of the major challenges acute trusts are addressing are:

Reshaping acute services

Acute trusts are working closely with other health system partners to deliver more effective care in the most appropriate setting, rising to the emerging choice agenda, redesigning services to meet the 18-weeks target, achieving financial balance through increased productivity and efficiency, and improving the overall quality of services.

Working towards achieving foundation trust status

Working towards the financial and quality standards required to be in a position to apply for foundation trust status.

Taking on workforce issues

Tackling a range of workforce issues, such as the European Working Time Directive and the impacts of implementing the Modernising Medical Careers programme, in planning acute services for the future.

In order to meet these challenges, acute trusts are looking for:

• system management tools that work with, rather than against, the move towards increased care in the community with the launch of Our health, Our care, Our say (466Kb PDF)
• clarity on the future standards for achieving foundation trust status and what faces non-foundation trusts beyond 2008
• the flexibility to make difficult local decisions, free from political interference, that challenge the traditional bricks and mortar image of acute hospital care
• the recognition that trusts need to be able to establish long term strategic and business plan goals, rather than operating on restrictive yearly plans to tackle long standing financial challenges.

As well as aiming to support the needs of the specific parts of our membership wherever possible, as a membership organisation the NHS Confederation represents all parts of the NHS. Our work for acute trusts feeds into the voice for the whole NHS, and supports solutions that benefit the whole system for patients and the public.