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Many countries are really worried about their acute hospitals and whether the business models they operate really work anymore. “There’s good reason why we group things together in hospitals. There’s economies of scope and scale, but... I think we’re running out of those and some of the very big models that we’re creating now... I think are so complex that the costs of running them are probably outweighing any of the benefits that we’ve been getting from scale.” They’re also increasingly not really able to deal with the very complex patients that we get but in some ways also underspecified for the most specialist care.
So, a lot of conversation going on about how one unbundles some of the current activities that they do and reorganised that but to be honest I don’t think we have the answer yet. So it’s an awful lot of effort going into just trying to make them run better, faster and cheaper which is good, but we’re going to have to go a step further and think about how we reconstruct some of those models completely.
In the medium to longer-term we have to rethink the model integrate it more with local services, get it to be much better at the management of chronic disease and supporting primary care and to really change the way that many of the doctors and other clinical staff in them work.
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