A study to understand and optimise community hospital ward care in the NHS (MOCHA)

Research studies support the community hospital as an effective bed-based rehabilitation service for older people compared to general hospitals. However, two national surveys by NHS Benchmarking show that measures of community hospital care (staffing, leadership, length of stay, outcomes and costs) vary greatly between community hospitals. It is not known why such differences occur, or how they affect care quality and costs. There are alternatives to community hospital ward care such as short-term rehabilitation at home or in residential care homes but differences in results for patients and costs between service types are unclear. This proposed study will address these issues. 

We will use two new NHS Benchmarking Surveys (Community Hospitals and National Audit of Intermediate Care) to describe the current and potential performance of community hospital in-patient care for older people and compare results and costs between community hospital wards and other short term rehabilitation services for older people. We will analyse the survey results using health economic methods to identify the important characteristics affecting the quality of patient care and costs; presenting the findings for discussion to The Patients Association and the Community Hospitals Association. We will then use the results to select 3- 4 community hospital wards that vary in their performance in which to conduct in depth case studies. These will provide a detailed picture of the structure, content and process of delivery of in-patient care for older people from the dual perspectives of service providers and service users. They will also examine the role and purpose of the community hospital within the wider intermediate care system. Finally, we will produce a web-based toolkit available to NHS teams to collect, analyse and review the characteristics of their community hospital wards and help them to develop a plan to improve the quality of care provided.