How does an NHS hospital work?

How does an NHS hospital work?

All patients are under the care of a hospital consultant (senior doctor) who works there, when you have contact with a hospital.

This is because patients are usually there as their GP has referred them to the hospital to see a consultant – as they don’t feel able to give you the care they need. This may be because they do not have the specialist knowledge of a consultant, or their clinical skills (e.g. a surgeon who can do an operation). But remember a GP has to know quite a lot about 10 parts of your body, whereas a hospital consultant has to know a lot about one part of it.

Some patients will have gone to A&E (or a Walk-in or Urgent Care Centre or a Minor Illness/Injury Unit) themselves.

Whichever way patients go to hospital, they will be under the care of a consultant, whether they are:

1. Admitted as an emergency. Average length of stay is 6-7 days
2. Admitted for a planned operation. Similar length of stay. Some smaller operations (e.g. a hernia) can be done as a day case
3. Having a baby. Usually one night
4. Having a procedure (e.g. endoscopy, colonoscopy) or x-ray (eg a CT or MRI). Done as a day case
5. Having a treatment like physiotherapy or occupational therapy. Done as a day case
6. Coming up to an out-patient department. Done in a morning (most run 9am-12pm) or afternoon (2-5pm).

They may or may not meet that consultant. But the consultant leads – and is responsible for all aspects of the team (including ‘service departments’, see below) – and the care they deliver. All are working on behalf of that consultant.
Note. Patients should be encouraged to ask the name of their consultant, and write it down.

The staff working for them include: nurses, allied health professionals (see below), managerial and administration staff.

But. How does an NHS hospital work? Let’s start with where they will be.

Wards and departments

Most types of consultant have a ‘base ward‘ (of 20-30 beds) where similar patients are grouped. The ward will have some single rooms and some shared areas of 4-6 beds. Men and women are separated.

The consultant and his/her team will work in one of 15-25 ‘departments’ (i.e. doctors and nurses specialising in the same group of diseases).  Each department will have 5-20 consultants, and 100s of nurses and other staff. Depending on size of hospital, there will be a total of 2000-7000 staff looking after 400-1200 ‘inpatients’ (i.e. admitted).

Such departments are grouped into bigger entities called ‘Divisions’ (or ‘Directorates’ or ‘Groups’), which comprise similar departments. Divisions vary from hospital to hospital. There are usually about 5-7 of them. Here are some common divisions with examples of departments in them.

• ‘Medicine’: General (e.g. Acute and Geriatric) Medicine; Specialist Medicine (e.g. Diabetes, Dermatology, Gastroenterology, Rheumatology, Neurology, Cardiology and Respiratory)
• Surgery: General Surgery, Trauma & Orthopaedics; Specialist Surgery (e.g. Breast and Vascular)
• Womens and Children: Obstetrics & Gynaecology, and Paediatrics
• Urgent Care: A&E, and ICU. In some hospitals Acute Medicine may be in this division
• Allied Health Professionals: Physiotherapy, Occupational Therapy, Dietetics, Speech and Language Therapy (SALT) and Psychology
• Support: Outpatients, Operating Theatres, Infection Control, Pharmacy, Radiology and Pathology.

Leading each Division and Department, is a triad of a senior doctor, nurse and manager. The doctor is usually the ‘head of department’ or ‘head of division’. Though all these roles have a variety of titles.

The larger regional ‘Teaching hospitals’ may have extra specialised departments like renal medicine/transplantation, plastic surgery etc. They may also have extra departments like Research and Development, and Innovation.

There are other (non-clinical) services that work across the hospital in all departments, e.g. IT, estates, domestic/catering, portering etc (these may be NHS or private sector).

Working patterns

Doctors: consultants work 8-24 hour shifts; registrars (middle grade doctors) and junior doctors 8-12 hours. Nurses work 8-12 hour shifts. Allied health professionals and other staff work 8 hour shifts.

Weekends and bank holidays

Hospitals are open for emergencies at weekends and on bank holidays; but few routine planned operations, x-rays (like CTs and MRIs) and outpatient clinics occur [“many including CKDEx believe they should be fully open. Ed”]. They are not fully staffed with few senior doctors there.

Executive board

‘Above’ the Departments and Divisions, there is an Executive Board which is ‘in charge’. The board comprises a Chairperson and Non-Executive Directors, and Executive Directors (‘Executives’). There is usually a core group of five executives, comprising:

• Three managers: Chief Executive Officer (CEO; most senior person or ‘Accountable Officer, AO)’, Chief Operating Officer (COO) and Chief Finance Office (CFO)
• A doctor: Chief Medical Officer (CMO). They will be a hospital consultant. They are sometimes assisted by a ‘Chief Registrar‘, who keeps them in touch with other registrars and junior doctors
• A nurse: Chief Nursing Officer (CNO).

Performance and Inspection
Key NHS targets are used to judge the performance of hospitals. They are inspected regularly by the Care Quality Commission (CQC) and given one of four grades: outstanding, good, requires improvement or inadequate.

Hierarchy, and junior and senior staff

Hospitals can seem hierarchical, especially to medical students and junior doctors. They have to have some structure as they are so big. But there is nothing to be frightened of. We all became health professionals as we wanted to help people. So senior staff – whether they be doctors, nurses or managers – will be more than willing to help junior staff, if they have a problem. We have all ‘been there’. If in doubt whether to mention an issue, always pursue your concern – whether it be about an individual patient, a colleague or how a department works.

Summary

How does an NHS hospital work? Patients will be under the care of a hospital consultant, with a team helping him/her. But there are many others that contribute to their care (including you!), as described above.

Other resources

This is a good video that describes how a hospital works, with an emphasis on what all the staff do.