System-wide change and shift in 'default setting' for care vital for NHS


06 / 3 / 2013 12.42pm

Published today, Transforming local care argues that much-needed change must go hand-in-hand with the development of more health services delivered in the community and in people's homes.

Clinically effective

Reserving inpatient care in major hospitals for people with life-threatening conditions or those needing complex surgery could be more clinically effective and make better use of NHS resources, the report says.

Shifting 'default setting'

It argues that the NHS and the public need to shift their 'default setting' for delivering healthcare from hospitals to the community and the home, where it is in the patients best interests.

"For too long, the default setting when we think about healthcare 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", said Jo Webber, interim director of policy at the NHS Confederation.

Call for action

The NHS Confederation is calling on the Government and the NHS Commissioning Board to facilitate the necessary change by ensuring health and social care funding supports the transfer of care into community settings.

Development of payment systems that reward prevention, early intervention and integrated working, as well as reinvestment of efficiency savings to support community-based service delivery, could transform the quality and sustainability of health and social care services.

Ms Webber added that: "There are already groundbreaking 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."

Transforming care delivery

The report cites examples of where providers of community services are already transforming care delivery and says they should be allowed to go even further. Examples include:

  • Development of a 24-hour access process for community health services, reducing emergency hospital admissions. A team from Birmingham Community Healthcare NHS Trust delivers rapid response and advanced assessment within two hours of an urgent referral to its single point of access, as well a multi-disciplinary response for non-urgent referrals.
  • Community-based rehabilitation programmes to help break the 'admission, loss of independence, re-admission' cycle, such as Norfolk Community Trust's Early Supported Discharge team, which provides intensive post-acute rehabilitation for stroke patients, allowing them to return to their own homes rather than a nursing home.
  • Assistive technology or 'telehealth', which allows patients with long-term conditions to have their vital signs monitored by clinicians without needing to leave their home. A scheme in Liverpool saw a 73 per cent reduction in emergency hospital admissions for acute coronary syndrome.

Find out more

Download Transforming local care: community healthcare rises to the challenge and other related publications:

Making integrated out-of-hospital care a reality

Realising the benefits of community health services

.Community Health Services ForumFind out more about the 

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