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The ability to sequence and understand different variants of the SARS-CoV-2 virus and their impact is crucial to inform policy and public health decisions. Soon after the UK went into its first lockdown in March 2020, the CCOVID-19 Genomics UK (COG-UK) Consortium was launched. COG-UK is a collaboration of experts in pathogen genomics including academic institutions, public health agencies, the Wellcome Sanger Institute, NHS Trusts and Lighthouse Labs. RAND Europe evaluated how COG-UK delivered against its objectives, for example how it contributed to advancing scientific knowledge about SARS-CoV-2, informing public health decisions, and providing information that can be used to evaluate the effectiveness of vaccines and treatments. The evaluation also examined the diverse factors that influenced COG-UK progress and impact, including enablers and challenges, and considered implications for the future.

Healthcare systems with limited resources face rising demand pressures. Healthcare decision-makers increasingly recognise the potential of innovation to help respond to this challenge and to support high-quality care. However, comprehensive and actionable evidence on how to realise this potential is lacking. We adopt sociotechnical systems and innovation systems theoretical perspectives to examine conditions that can support and sustain innovating healthcare systems. We use primary data focussing on England (with 670 contributions over time) and triangulate findings against globally-relevant literature. We discuss the complexity of factors influencing an innovating healthcare system’s ability to support the development and uptake of innovations and share practical learning about changes in policy, culture, and behaviour that could support system improvement. Three themes are examined in detail: skills, capabilities, and leadership; motivations and accountabilities; and collaboration and coordination. We also contribute to advancing applications of sociotechnical systems thinking to major societal transformation challenges.

Introduction: For more than a decade the English NHS has pursued integrated care through three national pilot programmes. The independent evaluators of these programmes here identify several common themes that inform the development of integrated care. Description: The three pilot programmes shared the aim of better coordination between hospital and community-based health services and between health and social care. Each programme recruited local pilot sites that designed specific interventions to support inter-professional and inter-organisational collaboration. The pilots were highly heterogenous and results varied both within and between the three programmes. While staff were generally positive about their achievements, pilots had mixed success especially in reducing unplanned hospital admissions. Common facilitators to achieving pilots’ objectives included effective senior leadership and shared values, simple interventions and additional funding. Barriers included short timescales, poor professional engagement, information and data sharing problems, and conflicts with changing national policy. Discussion: There was little stable or shared understanding of what ‘integrated care’ meant resulting in different practices and priorities. An increasing focus on reducing unplanned hospital use among national sponsors created a mismatch in expectations between local and national actors. Conclusion: Pilots in all three national programmes made some headway against their objectives but were limited in their impact on unplanned hospital admissions.

Purpose The purpose of this paper is to explore the outcomes identified by the evaluation of the national programme of integrated care pilots (ICPs) in England in the context of wider policies designed to deliver integrated care and to consider the challenges presented to policy makers and evaluators in distilling usable insights to promote effective policy. Design/methodology/approach This is a review of the ICP evaluation findings and the findings of a number of systematic reviews into aspects of integrated care. This paper shows the contextual analysis of these findings in relation to health policy in England. Findings The evaluation of ICPs in 2012 produced mixed results with some potentially useful findings for policy makers. However, numerous integrated care initiatives succeeded the ICPs suggesting that insights from evaluation are of limited usefulness to policy makers or are difficult to implement. A shift in macro policy within the English NHS may support integrated care by aligning objectives of clinical teams with those of the wider systems within which they operate. Research limitations/implications This review has not been based on a systematic review of the evidence on integrated care and reflects the personal experiences and views of the authors who have been active in this field of research for many years. Originality/value This paper considers why evaluation findings appear limited in their impact on policy in the field of integrated care. Views as to how evaluation might be undertaken so that it generates actionable insights are advanced.

96% of the veterinary profession agrees that Quality Improvement improves veterinary care. While clinical governance is an RCVS professional requirement, over the last year only 60% spent up to 3 days on the quality improvement activities which allow clinical governance to take place. 11% spent no time on it at all. A lack of time, know-how and organisational support were among the barriers preventing its adoption in practice. Rather than being an individual reaction to a problem, Quality Improvement is a formal approach to embedding a set of recognised practices, including clinical audit, significant event audit, guidelines and protocols, benchmarking and checklists. This framework should be applied within a just culture where errors are redefined as learning opportunities, and precedence is given to communication, team-work and team-morale, patient safety, and distributed leadership. Addressing this gap will require evolution – rather than a revolution. Persistent packages, given enough time and addressing the whole flow of the patient journey, trump one-off ‘heroic’ and narrowly-focused interventions. Creating a rhythm of learning alongside stability of practice allows lessons to be absorbed and improvements routinised. Doing good things well is better than doing perfect things sporadically and helps address the widespread concern that there is insufficient time for QI by making the time commitment more predictable and manageable. The research provides a robust, evidence-based, roadmap for the entire sector including professional organisations, educators, those in management positions and care providers.

Transforming health and care for older people is complex and demanding. Evaluating such efforts requires a range of approaches and ideas, and a reflection on ways to improve how evaluations are commissioned, completed and used in a changing policy landscape. This article by researchers at RAND Europe summarises three workshops undertaken with evaluators, commissioners of evaluations and services, and those delivering services that are evaluated with the explicit aim of addressing these questions.

Despite previous research, the field of counter-violent-extremism has not benefited significantly from evaluation. By comparison, and despite a number of challenges, the evidence-based healthcare movement has an established track record of using evaluation to develop practice. We seek lessons from the evidence-based healthcare movement about what it might take to develop evaluation capacity in the emerging field of counter-violent-extremism. Based on this, we offer a framework for measurement in counter-violent-extremism: the ‘Violent Extremism Evaluation Measurement Framework’. We map out states and manifestations associated with violent extremism and radicalisation, then suggest how to measure levels and changes in relevant attributes.

In light of the challenges facing the NHS, RAND Europe and the University of Manchester were asked to conduct a study on the potential of innovation to help deliver an efficient and effective healthcare service.

The NHS is under pressure to meet the changing demand for services with limited resources. Innovations spanning technologies, products, services and new ways of working provide opportunities to respond creatively and effectively to growing health demands across all age groups. RAND Europe and the University of Manchester were asked to conduct a study on the potential of innovation to help deliver an efficient and effective healthcare service.

RAND Europe has been a 'critical friend' of Q from 2016 to 2020. The first two years of this evaluation were primarily formative in approach, focusing on how Q was designed and established, and feeding the data back to the Q team to inform the ongoing design of Q. The later stages of the evaluation took a more summative approach, focusing on the impact of Q on its members as well as on its wider contributions to healthcare improvement.

An embedded evaluation of the Health Foundation's Q Initiative was conducted by RAND Europe from 2016 to 2020. The findings of the evaluation demonstrate how Q has impacted its members and national healthcare improvement work.

From the Website Description: "Long before the unprecedented pressures placed on adult social care by COVID19 [coronavirus disease 2019], it was evident that the challenges being faced by the sector were at risk of overwhelming it Our targeted discussions on this topic predate COVID19, but we believe that recent events have made the conclusions presented here even more relevant We are not focused on how to get ever more out of existing arrangements but, rather, on how to innovate The demand for adult social care in the UK is rising and will continue to rise But the supply of such care is struggling to keep up The result is that increasing numbers of people are being left without some of the support they need Part of the answer to matching supply to demand undoubtedly requires increased public funding But another important contribution to more closely matching the provision of social care to the demand for it is innovation Innovation in social care can enable more and better care to be delivered more cost-effectively The main focus of this Perspective is on ideas to stimulate and sustain innovation in social care;and ideas for research to bring closer a system of sustainable social care innovation "

The demand for health services in England is both growing and changing in nature, yet resources are limited in their ability to respond to the scale and scope of need. As a result, the NHS is under increasing pressures to realise productivity gains, while continuing to deliver high quality care. RAND Europe and the University of Manchester have been commissioned to conduct a study to examine the potential of innovation to respond to the challenges the NHS faces, and to help deliver value for money, efficient and effective services. "Innovation" in this study refers to any product, technology or service that is new to the NHS, or applied in a new way, aimed at delivering affordable and improved care. The learning we have gained adds considerable depth to the practical discussions presented regarding how innovation can be first nurtured and then made meaningful and actionable in a variety of settings. This is important given the complexity of health innovation systems and the diversity of elements that need to interact and work together for the overall system to function effectively. We share insights related to skills, capabilities and leadership; motivations and accountabilities; information and evidence; relationships and networks; patient and public engagement; and funding and commissioning. We will develop these detailed learning points into a more systematic analysis as the research evolves. The research is funded by the Department of Health Policy Research Programme, in close collaboration with NHS England and the Office of Life Sciences.

Communities of Practice (CoPs) are self-organising and self-governing groups of people who strive to be better practitioners by developing and spreading new knowledge and practices. CoPs are seen as valuable means to improve collective learning in health and social care, but measuring their effect is difficult. This scoping study collected data to assess the feasibility of, and best approach to, a full-scale evaluation of CoPs.

Q is an initiative is led by the Health Foundation and supported and co-funded by NHS England to connect people working in quality improvement across the healthcare system throughout the UK. RAND Europe was commissioned to provide an independent evaluation of Q, starting in 2016 and reporting in early 2020. This is the interim report of that evaluation, documenting progress towards the overarching evaluation aims.

Dance4Life, an international NGO working with young people on health and promotion of safe sexual choices, wanted to develop their understanding of new implementation and social franchising pilots. RAND Europe delivered a process evaluation that provided evidence on these pilots. The evaluation employed several data collection methods (document review, interviews, surveys and ecological momentary assessments) to provide evidence on the pilots.

The first Q Improvement Lab ('Q Lab'), funded by the Health Foundation and NHS Improvement, was launched in the spring of 2017. RAND Europe and the University of Cambridge conducted a real-time, formative evaluation to address the overarching question: 'Is the Q Lab approach likely to become an effective, valuable way of developing ideas or interventions to support positive change at multiple levels of the health and care system?

BackgroundThe notion of a community hospital in England is evolving from the traditional model of a local hospital staffed by general practitioners and nurses and serving mainly rural populations. Along with the diversification of models, there is a renewed policy interest in community hospitals and their potential to deliver integrated care. However, there is a need to better understand the role of different models of community hospitals within the wider health economy and an opportunity to learn from experiences of other countries to inform this potential.ObjectivesThis study sought to (1) define the nature and scope of service provision models that fit under the umbrella term ‘community hospital’ in the UK and other high-income countries, (2) analyse evidence of their effectiveness and efficiency, (3) explore the wider role and impact of community engagement in community hospitals, (4) understand how models in other countries operate and asses their role within the wider health-care system, and (5) identify the potential for community hospitals to perform an integrative role in the delivery of health and social care.MethodsA multimethod study including a scoping review of community hospital models, a linked systematic review of their effectiveness and efficiency, an analysis of experiences in Australia, Finland, Italy, Norway and Scotland, and case studies of four community hospitals in Finland, Italy and Scotland.ResultsThe evidence reviews found that community hospitals provide a diverse range of services, spanning primary, secondary and long-term care in geographical and health system contexts. They can offer an effective and efficient alternative to acute hospitals. Patient experience was frequently reported to be better at community hospitals, and the cost-effectiveness of some models was found to be similar to that of general hospitals, although evidence was limited. Evidence from other countries showed that community hospitals provide a wide spectrum of health services that lie on a continuum between serving a ‘geographic purpose’ and having a specific population focus, mainly older people. Structures continue to evolve as countries embark on major reforms to integrate health and social care. Case studies highlighted that it is important to consider local and national contexts when looking at how to transfer models across settings, how to overcome barriers to integration beyond location and how the community should be best represented.LimitationsThe use of a restricted definition may have excluded some relevant community hospital models, and the small number of countries and case studies included for comparison may limit the transferability of findings for England. Although this research provides detailed insights into community hospitals in five countries, it was not in its scope to include the perspective of patients in any depth.ConclusionsAt a time when emphasis is being placed on integrated and community-based care, community hospitals have the potential to assume a more strategic role in health-care delivery locally, providing care closer to people’s homes. There is a need for more research into the effectiveness and cost-effectiveness of community hospitals, the role of the community and optimal staff profile(s).FundingThe National Institute for Health Research Health Services and Delivery Research programme.

This article describes a review of the Biomedical Research Units (BRU) scheme, undertaken for the Department of Health. This review was a perceptions audit of senior executives involved in the scheme, and explored what impact they felt the scheme is having on the translational research landscape. More specifically, we investigated whether and how institutional relationships between NHS and academic partners, industry and other health research system players are changing because of the scheme; how the scheme is helping build critical mass in specific priority disease areas; and the effects of any changes on efforts to deliver the broader goals set out in Best Research for Best Health. The views presented are those of study informants only. The information obtained through our interviews suggests that the BRU scheme is significantly helping shape the health research system to pursue translational research and innovation, with the clear goal of realising patient benefit. The BRUs are already contributing to observable changes in institutional relationships between the NHS and academic partners: trusts and medical schools are collaborating more closely than in the past, have signed up to the same vision of translational research from bench to bedside, and are managing and governing targeted research resources more professionally and transparently than in the past. There is also a stronger emphasis on engaging industry and more strategic thinking about strengthening regional and national collaboration with other hospital trusts, PCTs, research organisations, networks and development agencies. The scheme is also transforming capacity building in the health research system. This includes (i) developing and modernising facilities and equipment for translation; (ii) building a critical mass of human resources through recruitment and training, as well as improving retention of existing expertise; and (iii) helping ensure a steady flow of funds needed to sustain research activity and accelerate movement through the innovation pipeline. A number of centres are also trying to recreate the BRU model in new disease areas, with their own resources.

The European Commission Health and Consumer Protection Directorate-General (DG SANCO) commissioned RAND Europe to provide support in developing a comprehensive data strategy for DG SANCO that meets the needs of increasingly evidence-based policymaking in the future. This work builds on previous work by RAND Europe conducted for DG SANCO, mapping out international good practice of data management. The work described in this study had two aims: to assess the current data management practices within DG SANCO that relate to the four specific issues identified by DG SANCO: data needs, DG SANCO data sources, key partnerships on data, and data quality; and to develop, on the basis of this review, recommendations for improving DG SANCO's current data management and the definition of DG SANCO's Good Practice Model for Data Strategy. This article presents the findings of RAND Europe's analysis.

Tobacco use is one of the largest avoidable causes of morbidity and premature death in the EU. Whilst smoking prevalence in the EU has been declining over the past 30 years, smoking has remained more prevalent among men than women in the EU-27, with some of the new Member States reporting the widest gaps between male and female smokers. For young smokers (13 to 15 years old) this situation is somewhat reversed, with slightly more girls than boys smoking. Against this background, the European Commission Directorate-General for Health and Consumer Protection (DG SANCO) considered a revision of the Tobacco Products Directive 2001/37/EC across five general areas: scope of the directive, labelling requirements, registration and market control fees, ingredients, and sales arrangements. More specifically, the types of policy options under consideration included (but were not limited to): an increase of warning label sizes on the back of packaging to 100%, a restriction for the display of products at retail outlets and an introduction of additional measurement method for TNCO (the modified ISO method) with maximum limits set accordingly. DG SANCO commissioned RAND Europe to provide support in assessing the potential health, macroeconomic, and compliance cost and administrative burden impacts of revising the Tobacco Products Directive. In addition to assessing impacts, the study provides an up-to-date overview of the evidence and basis for current tobacco product regulation that may be of interest to a wider audience interested in tobacco control policies.

The European Alcohol and Health Forum was launched in June 2007 following the adoption by the European Commission in October 2006 of the EU strategy to reduce alcohol-related harm. It began as a stakeholder platform of 50 founding members from production and sales organisations, media and advertising organisations, NGOs that work to limit alcohol-related harm, research organisations, professional bodies and others. Membership of the Forum is voluntary and members are expected to commit formally and publicly to concrete actions to reduce alcohol-related harm. These concrete actions are referred to as "commitments." Each commitment must be put in writing in a standardised commitment form, which also includes monitoring information. Such information includes details of the objectives of the commitments, resources allocated to them and outputs produced, as well as dissemination of the results of the commitments alongside other information.

This article describes a study scoping the issues involved in considering the merits of using prizes to support the objectives of the Department of Health Research and Development Directorate (DH R&D). The paper concludes that there is indeed merit in developing incentives to support excellence in health research in addition to “standard” performance management and routine inspection. These could act either to reinforce the signals created by standard metrics (for example, awards recognising the best performers as measured by standard metrics) or they could “fill the gaps” to encourage behaviour not influenced by conventional incentives. This would create an ecosystem to more effectively link reward with motivation, which could deliver benefits for patients and the health care system more widely. Prizes, it is argued, should play a more significant role in the UK health R&D system than in the past, but it is not suggested that they replace existing systems to support high-quality research and development.

RAND Europe and the University of Manchester have been commissioned to conduct a study to examine the potential of innovation to respond to the challenges the NHS faces, and to help deliver value for money, efficient and effective services.

Urgent and Emergency Care (UEC) vanguards aim to improve the quality, efficiency and effectiveness of UEC services so that patients receive the most appropriate care at the right time and in the right place, and so that unnecessary admissions to accident and emergency (A&E) and hospitals are reduced. The Southern Cluster comprises three such UEC vanguards. RAND Europe's evaluation examined the impacts of the vanguards, the processes underpinning delivery (and associated enablers and challenges), and implications for future policy and practice. The evaluation used a multi-method approach, including theories of change, document review, workshops, interviews, surveys and data dashboards. The Southern Cluster UEC vanguards have made progress across core activities. Clinical hubs are operational across the sites. Direct booking capacity into primary care is progressing more with out-of-hours than with in-hours services. Gradual but variable progress has been made towards joint planning and governance of UEC services. Efforts to ensure seamless data sharing between providers, and interoperable IT infrastructure are progressing somewhat slower than originally hoped. Vanguard funding, committed leadership and practical mechanisms to support joint working helped drive progress. Public engagement, workforce-capacity and data interoperability will need to be addressed for longer-term impact at scale. The study makes recommendations concerning: (i) UEC health and care workforce capacity-building, (ii) local-national coordination around UEC transformation, (iii) collaboration across localities and professions, (iv) support for an end-to-end UEC pathway with mutually reinforcing activities, (v) cost and outcome data, (vi) an interoperable data infrastructure, and (vii) capacity for evaluation and learning.

The Department of Health and the Wellcome Trust, in co-operation with NHS England, asked RAND Europe to conduct a limited consultation with key stakeholders about the practicality of measures and incentives proposed as part of the NHS Accelerated Access Review (AAR), which aims to assess the pathways for the development, assessment, and adoption of innovative medicines and medical technology. Through a focused engagement exercise with key healthcare stakeholders this project explored the implications of selected interim AAR propositions and feasibility of implementation for key actors, in primary and secondary care as well as commissioners and academia. Specifically, the project investigated the feasibility of implementation of three specific propositions including: a new earmarked fund to encourage AHSNs and other key innovation actors to re-design systems to embrace innovation; mobilising the influence of clinical system leaders to champion change; and encouraging secondary care organisations to take on "innovation champion" roles linked to financial incentives and a new emphasis on accountable care organisations. Data was collected on the feasibility of the three AAR propositions from a workshop with AHSN CEOs and Commercial Directors and interviews with senior NHS staff in three AHSN regions (South West, University College London Partners, and North East, North Cumbria). The study concludes with reflections on the feasibility of each recommendation and identifies factors expected to facilitate or challenge their implementation, as well as considering the wider cross cutting issues that may influence the adoption and diffusion of innovation in the NHS.

This article discusses an approach to managing the evaluation of complex interventions. Complex interventions pose significant challenges to the role and conduct of evaluations. In particular, they combine with reflexive learning and change to produce significant uncertainties making it hard to describe in advance what the intervention will do or what the outcomes might be. These uncertainties vary in nature and addressing these uncertainties leads to different evaluation approaches. That such evaluations often take place in ‘real time’ and have a strong formative dimension adds to the challenge. This article proposes a way of approaching this problem by incorporating the concepts of uncertainty and complexity into a Theory of Change-based approach.

To foster economic research on growth in poor and developing countries the Department for International Development in the UK has provided funding to several organisations focused on economic growth research. Of interest for this study were six individual programmes. The aim of this review was to compare the six programmes over time, against each other, and against relevant benchmarks to capture their performance to date.

The Emergency Education Response Programme (EER), launched by UNICEF, the Government of Jordan and partners in 2012, aims to provide free public formal education, as well as safe and appropriate supportive educational services, for Syrian refugee children living in Jordan. RAND's evaluation identified significant successes as well as longer-term challenges, related to education access and quality and programme planning and coordination. The Programme's first responses to the Syrian refugee crisis were designed to meet immediate education needs, enabling many children to enrol in school. However, as the crisis has continued, medium-term, strategic efforts and planning have lagged behind events on the ground. Although the EER has successfully provided access to public education for 130,000 Syrian children, at least 97,000 remain out of formal school. Increasing Syrian access to formal education, as well as ensuring high-quality schooling for both Syrian refugees and Jordanian host communities, will require more attention. The Programme has also provided NGO-managed alternative education to 35,000 Syrian children. While they were reported to provide quality, child-centered, flexible education, they have lacked a full-time, structured curriculum and a coherent quality monitoring, and clear pathways for entry into formal education. Effective planning and coordination has been strengthened by improved data on implementing partners' activities. However, little evidence was found that planning decisions were being made on the basis of evaluating and comparing options. Key recommendations based on evaluation findings concern developing medium-term thinking, expanding public education, improving double-shifted schools and targeting gendered challenges, among others.

Chronic obstructive pulmonary disease (COPD) carries a high symptom burden. Management of patients with advanced COPD should address patients' symptoms and care needs, optimise daily functioning and stabilise health status. The Living with Breathlessness study explored the question of how patients' and carers' needs change along the trajectory of advanced COPD and how guidelines should be amended to meet these changing needs. Six recommendations emerged from the study; we carried out an online survey of stakeholders who work with people living with advanced COPD in order to explore whether they agreed that the recommendations would improve care for people with COPD and what their opinions were on the ease of implementation of such recommendations in their place of work. Overall there was high agreement that all of the recommendations would improve care and support for people with advanced COPD; however, the survey also revealed caution around the ease of implementing some of these recommendations, as well as variation in responses among professional groups and settings. Concerns largely focused on the time and resources needed to implement the recommendations and, in particular, the resources needed to respond appropriately to any unmet needs identified through the more patient-focused and holistic analysis of patient and carer needs that these recommendations represent. The evidence from this survey suggests that there is a significant level of support for these recommendations among healthcare practitioners working with people with COPD. The vast majority of survey respondents agreed that each of the recommendations has the potential to improve the quality of life for COPD patients.

The Integrated Personal Commissioning (IPC) Programme is a new programme that joins up health and social care funding for individuals with complex needs and gives them greater control over how their combined budget is used. This report sets out the support RAND Europe provided for the roll-out of the programme at the nine demonstrator sites, including workshops to support the development of the logic models behind local plans.

Q is an initiative, led by the Health Foundation and supported by NHS England, designed to connect people skilled in quality improvement across the UK. The Q founding cohort comprised 231 members who attended three two-day 'design events'. We carried out an embedded evaluation of the first phase of Q, to look at both the success of the design process and the potential for success for Q, while providing continuous findings to the Q project team.

The Department of Health's Innovation, Health and Wealth (IHW) strategy aimed to introduce a more strategic approach to the spread of innovation across the NHS. This study represents the first phase of a three-year evaluation and aims to map progress towards the IHW strategy and its component actions. This evaluation used a combination of quantitative and qualitative methods: document review, key informant interviews and stakeholder survey. This study also forms the basis for selecting case studies for phase two of the evaluation. Our findings from the interviews and survey suggest broad stakeholder support for the overarching ambitions of the IHW strategy. However, we found variable progress towards the overarching objectives of the eight IHW themes and an ambiguous relationship between many of the themes' objectives and their actions. It was difficult to assess progress on IHW's actions as commitment to the actions, implementation guidance and expected outcomes of the actions were not clearly articulated. The Academic Health Science Networks (AHSNs) and the Small Business Research Initiative (SBRI) were reported to be working well, which may be attributed to their clear structures of accountability and earmarked budgets. However, survey respondents and interviewees raised concerns that budgetary pressures may limit the impact of both AHSNs and the SBRI. The main challenges identified for ongoing action were the resources available for their implementation (e.g. Medtech Briefings), lack of awareness of the initiative (e.g. the NICE Implementation Collaborative) and the design of the actions (e.g. the Innovation Scorecard, web portal and High Impact Innovations).

Background: There is no single definition of a community hospital in the UK, despite its long history. We sought to understand the nature and scope of service provision in community hospitals, within the UK and other high-income countries. Methods: We undertook a scoping review of literature on community hospitals published from 2005 to 2014. Data were extracted on features of the hospital model and the services provided, with results presented as a narrative synthesis. Results: 75 studies were included from ten countries. Community hospitals provide a wide range of services, with wide diversity of provision appearing to reflect local needs. Community hospitals are staffed by a mixture of general practitioners (GPs), nurses, allied health professionals and healthcare assistants. We found many examples of collaborative working arrangements between community hospitals and other health care organisations, including colocation of services, shared workforce with primary care and close collaboration with acute specialists. Conclusions: Community hospitals are able to provide a diverse range of services, responding to geographical and health system contexts. Their collaborative nature may be particularly important in the design of future models of care delivery, where emphasis is placed on integration of care with a key focus on patient-centred care.