Consultation outcome

Challenges facing small acute NHS hospitals

This consultation has concluded

Download the full outcome

Detail of outcome

Monitor’s research has found no clear evidence that smaller acute hospitals performed any worse clinically than larger counterparts.

The analysis of a variety of clinical measures found no systematic evidence of poorer quality in small hospitals and found only a limited effect of size on financial performance, but this is likely to become more important in the future. This is largely as a result of:

  • trends towards the drive to increase staff in the acute sector
  • further consolidation of specialist care
  • moves to improve the delivery of care out of hospital

Next steps

Monitor will work with NHS healthcare providers and commissioners, its national partners and healthcare experts to help identify the new models of care that can better address the underlying causes of financial challenge at individual NHS providers and in specific local health economies. This will include understanding the economic impact of moving care out of hospital and the extent to which it might generate savings for commissioners.

Original consultation

This consultation ran from to


Monitor wants to find out about the challenges smaller district general hospitals face in delivering high-quality, sustainable care to patients.


Consultation description

The initial focus of this call for evidence is on smaller acute NHS providers with an annual income of £300 million or less. However, Monitor would like to hear from acute providers of all sizes, as this will help determine if smaller providers face significantly different challenges to larger ones.

Monitor is looking for evidence on:

  • whether smaller non-specialist acute providers are facing particular difficulties in delivering high-quality, sustainable services
  • factors that may affect providers’ ability to deliver high-quality services to patients or to respond to issues
  • the opportunities they have to address potential challenges and to demonstrate innovative, high-quality service delivery
  • whether factors other than size may pose challenges to providers