NHS European Office

The new care models can learn lessons from Germany | Ron Agble


What can the UK learn from Germany’s approach to running provider hospital groups? That was the question a number of new care model programme vanguards explored with a delegation from the German Hospital Federation during a *recent visit to London. Here Dr Ron Agble reflects on the discussions.
It turns out that we can learn quite a lot from the German model of running provider hospitals.
Yes, some of the starting points are different: what we consider to be a ‘small’ hospital (£250 million turnover) is large by German standards and their provider landscape is already quite diverse with public hospitals, not-for-profit hospitals and private hospitals all playing a sizeable part in mainstream healthcare. 

It is particularly interesting that their ‘faith’ sector still has such an active role in hospital care, with a lot of hospitals run by religious institutions – why isn’t that the case in the UK?

What we do have in common is that our healthcare systems share many challenges: the perceived variation in quality between providers, the imperative to improve efficiency and financial sustainability of smaller units, and difficulties recruiting doctors and nurses. 
And there were some common objectives regarding standardisation of clinical practice, the creation of clinical networks and the consolidation of back-office support. Sound familiar?
German hospital groups have been developing to focus on these areas – particularly in the not-for-profit and private sectors. In some cases, struggling public sector units have been taken over by non-public sector hospital groups. 
As one would expect, this has not been without controversy. Proponents of the approach point to increased investment in technology and equipment which, combined with updated ways of working, deliver better quality at lower cost. 
And what about the organisational structures and forms in these hospital groups?
As you might expect, there wasn’t a one-size-fits-all approach. Some arrangements looked looser, with high levels of local autonomy at unit level for policies and practices. Others were clearly aiming for more tightly connected and standardised units. It seems clinicians’ perceptions of these types of developments are quite similar in both our health systems –  professional identity clearly travels well! 
There was also some more nuanced debate about the optimal geographical distribution of hospital groups, with advocates of both approaches: local focus and international spread. At which point, news reached of a German hospital group that recently acquired 50 hospitals in Spain…
Overall, it seems we can share in the learning from our German colleagues about some obvious do’s and don’ts in developing hospital groups. This is a dialogue we look forward to continuing.

Dr Ronald Agble is director of partnerships and transactions at the Royal Free London NHS Foundation Trust. Follow the trust on Twitter @RoyalFreeNHS

*A delegation of German hospital and hospital chain chief executives came to London on 6 October as part of a visit organised by the NHS European Office and led by the German Hospital Federation.

Discover more about hospital chains

In early 2017, the NHS European Office will be holding a webinar on German hospital chains, as part of its European Models of Care Programme which is back by popular demand.

Find out more about the programme on the NHS European Office website.

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