Despite the NHS’ drive to shift more care into community settings, hospital-based specialist centres will be vital in underpinning new models of care, writes Professor Charles Knight OBE, Chief Executive of St Bartholomew’s Hospital.

Wes Streeting is right: for the NHS to survive and thrive, it must evolve. That means moving care out of hospitals and into communities, replacing outdated systems with digital ones, and shifting the focus from treating illness to preventing it. These aren’t minor tweaks – they represent a fundamental reshaping of how we deliver care.

But if we’re serious about that future, we must not overlook centres of excellence. Hospital-based specialist centres are not relics of the past – they are vital to the NHS of tomorrow.

At first glance, these centres might seem at odds with a local, preventative approach. In reality, they underpin it. Centres of excellence set national standards, train the workforce, lead research and innovation, and crucially, save lives at scale.

The Barts Heart Centre in east London is a case in point. Based at St Bartholomew’s Hospital – the oldest hospital in the country and now one of its most advanced – the centre was created ten years ago by consolidating cardiac services across the capital. It is now one of Europe’s largest cardiac centres. It set out to treat 80,000 patients and save 1,000 lives a year – goals it has exceeded. Outcomes have improved, variation narrowed, and patients receive faster, more effective care.

But Barts is more than a clinical powerhouse – it’s a research leader. Delivering more cardiovascular studies than any other UK centre, its work shapes national guidelines, informs NHS practice, and brings new treatments to patients faster.

And its impact extends far beyond hospital walls. The Heart Centre is embedded in its community – supporting Parkruns, delivering school talks, taking part in local health campaigns, and acting as an anchor institution. Prevention is core to its work: clinicians use data and research to spot early signs of heart disease and intervene sooner, helping people stay healthier for longer.

Centres like Barts are already delivering on the Health Secretary’s three major shifts:

  • From hospital to community: By partnering with GPs, community teams and local authorities, they design integrated care pathways that begin well before a hospital referral.
  • From analogue to digital: As early adopters of remote monitoring, AI diagnostics and data-sharing platforms, they pilot innovations that can be scaled across the NHS.
  • From sickness to prevention: With large patient populations, rich datasets and academic partnerships, centres of excellence put prevention at the heart of their mission.

This is the future of care – joined-up, digitally enabled, and prevention-focused. Centres like Barts provide a clear blueprint for how to get there.

That’s why Barts Health NHS Trust, which runs the Heart Centre, is developing more centres of excellence across our hospitals. We’re already moving in that direction – through the major trauma centre at The Royal London, our orthopaedic centre at Newham, and the academic centre for healthy ageing at Whipps Cross. These are centres of excellence for our group of hospitals, delivering specialist care to patients across our diverse catchment.

The NHS’s 10-Year Health Plan is a critical opportunity to build on this progress. But to succeed, we must invest properly in these centres – in their people, technology, and infrastructure. Centres of excellence stand ready to lead the way, delivering better, smarter, and more sustainable care for all.