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Keep hospitals only for the very sick, says new report

Shifting funds into community based care better for patients and public purse

Caroline White

Friday, 08 March 2013

Hospitals should be reserved for treating people with life threatening conditions or in need of complex surgery, with the bulk of care delivered in the community and in people’s homes, argues a new report published by the NHS Confederation’s Community Health Services Forum.

Such an approach would not only improve outcomes for patients, but it would make the NHS more efficient and better able to cope with the significant financial restraints if faces, says the report.

But the NHS and the public will need to shift their “default setting” from healthcare provision in hospitals to the community and the home where it is in the patient’s best interests.

“Shifting resources into community provision will require tough decisions to be made about reconfiguration and potential closures,” it says. “Overcoming public doubts over reconfiguration has been a difficult task, due in part to the affinity people have with local services, but also as a result of scant information about alternative provision,” it adds.

And it continues: “The NHS, along with government, needs to be more open and engage a great deal sooner with the public on proposed reconfigurations, emphasising that it is not about facilities or buildings, but about alternative and more appropriate services for patients.”

But community-based care also means a significant shift in funding, and an emphasis on investing in technologies to enable care to be delivered outside hospitals, says the report, which calls on the government and the NHS Commissioning Board to divert health and social care funds into community settings.

Payment systems that reward prevention, early intervention, and integrated working, along with reinvestment of efficiency savings to support community-based service delivery, could transform the quality and sustainability of health and social care services in the long run, the report argues.

Local providers and commissioners will need to work more closely together to achieve the necessary scale and pace of change, says the report. “This requires a collaborative approach, where risks and rewards are shared and organisational interests set aside, for the greater benefit of the local health economy,” it suggests.

The report highlights various examples of community-based services across the UK, including, a 24-hour access process for reducing emergency hospital admissions in Birmingham; an early supported discharge team to provide intensive rehabilitation for stroke patients in Norfolk; and a telehealth scheme in Liverpool for people with long term conditions, which cut emergency admissions for acute coronary syndrome by 73%.

And it points to a recent study, which suggests that improving mobile working for staff, coupled with a wider adoption of homecare and telehealth/care solutions, could save the NHS £3.4 billion a year.

Jo Webber, interim director of policy at the NHS Confederation, said that the scale of change required in health and social care was unprecedented, and demanded new ways of thinking.

"For too long, the default setting when we think about health care or support is to think of a hospital. But in reality, acute hospitals—whether major teaching sites or local district generals—are rarely the best place for someone who needs ongoing health or treatment,” she said.

“There are already ground-breaking services in place in some parts of the country, which are transforming patient experience and quality of care, as well as contributing to making the NHS more efficient overall. It is time we started thinking differently right across the country, and making sure investment supports innovative service delivery that supports patients' independence and recovery," she added.

Transforming local care: Community healthcare rises to the challenge

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