Shifting the balance of care: Great expectations
Nuffield Trust 1 March 2017
- Drawing on a review of the STPs and an in-depth literature review of 27 initiatives to move care out of hospital, the report looks their impact, particularly on cost, and what has contributed to their success or otherwise. ( A number of brief case studies are included)
- It explores five key areas: elective care, urgent and emergency care, admission avoidance and easier discharge, at risk populations, and self-care.
- The analysis suggests that some STPs are targeting up to 30% reductions in some areas of hospital activity, including outpatient care, A&E attendances and emergency inpatient care over the next four years but at the same time suggests that the falls in hospital activity projected in many STPs will be extremely difficult to realise as the economic benefits are frequently overstated.
- Where schemes have been most successful, they have: targeted particular patient populations; improved access to specialist expertise in the community; provided active support to patients including continuity of care; appropriately supported and trained staff; and addressed a gap in services rather than duplicating existing work.
- The report concludes that, while out-of-hospital care may be better for patients, it is not likely to be cheaper for the NHS in the short to medium term – and certainly not within the tight timescales under which the STPs are expected to deliver change. The wider problem remains: more patient-centred, efficient and appropriate models of care require more investment than is likely to be possible given the current funding envelope.
