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The NHS is now subject to much tighter regulatory controls than in the past and this means there is likely to be less appetite for risk.

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But conversely there are situations where some risk is supported for longer term potential benefit, such as the Royal Free London vanguard creating a group of hospitals. However such large-scale changes to organisational form need national and local system support.

Developing a networked care model should not be just about putting right what is wrong with the service but about pioneering best practice. A networked care model offers the opportunity to pilot innovation at a particular site without disrupting the whole network.

Extending a service increases the risk of variation; replicating best practice will facilitate standardisation.

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Researching our network history with past and present Moorfields colleagues, it has become clear that not all decisions made then would be possible in the current regulatory environment. Network growth was a clear strategy to ensure Moorfields’ sustainability as a single specialty hospital provider. With over 30 sites in England and three in the United Arab Emirates, this has been achieved in terms of national and international spread and reputation. We are the largest eye provider in the UK and in London and a world leader in ophthalmology research and education.

The challenge for trust leaders today is to ensure the sustainability of a network created before the regulatory regime intensified.

The single specialty market has less potential for diversification than do multispecialty organisations. Moorfields’ strategic pillars of clinical excellence, research and education define our trust as a national and international leader in ophthalmology and will drive future decision making. The scale of our network is unique within the NHS and we learned that the rationale for some of the network development was not always based on what was best for the trust financially, but was always in the best interests of our patients. We always wanted to sustain high quality eye care locally.Sustainability graphic

The biggest challenge now is the part that financial constraints, critical mass and workforce models will play in deciding where and when high quality services can be networked safely. This is in addition to the contribution they can make to the local and national commissioning agendas.

What is not clear is whether larger organisation-wide system models will address the sustainability issues faced by smaller hospital services. Whole-hospital solutions are just that and may not solve the problems that smaller hospitals regularly raise with single specialty providers.

Will single specialty networked care grow, stay the same or consolidate? These are questions for organisational strategy but what is clear is that sustainability will require tough decisions and brave leaders.

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