Healthcare delivery
Moving healthcare away from hospitals
Kate Woodhead RGN DMS discusses the opportunities and challenges associated with the vision of moving healthcare away from hospitals and into the community. She highlights some of the schemes that are already in place and outlines some of the main considerations.
Successive governments have made promises to move more care away from the acute sector and into the community. However, this major change has not materialised, to date. Not only has the promise been repeatedly broken but, worse still, more funds have been channelled into hospital care away from community and primary care. Much has been written about the issues in
the NHS, many are focused on hospital care and not just on the struggles in general practice. The great sadness of this whole issue is that demographic change has been coming for a long while and nothing has been done politically to ensure that the roof is fixed, while the sun shines. Into the complex picture, much of the acute sector has lost many acute beds in the last twenty years – leading to the current ignominious shame of corridor care. The King’s Fund describes different sets of about the purpose of moving care
assumptions1
closer to communities and states that these include: l Cost savings. l Reducing demand on hospitals (waiting lists, emergency admissions).
l Better experiences and outcomes for people who use health and care services.
l Improved service alignment or integration. l Developing population health and prevention at scale, including wellbeing, and tackling health inequalities.
They also suggest that as the health and care system is so complex, so are the solutions. They emphasise that a whole system shift is required, in order to meet the vision and to ensure that the system is sustainable for the future. The reason that this is so important is to deliver improved care and better outcomes for patients. The D’Arzi report2
suggested that there are
fundamental changes which are required to deliver the sort of care needed for patients, those are focusing on bringing care closer to communities, prioritising prevention over
treatment, embracing digital transformation and embedding financial discipline within the system. In order for this vision to be delivered, the NHS has to make not only fundamental change in the short term, but also to ensure that the strategy is long term. It will need constant review and dedicated investment. The Department of Health and Social Care (DHSC) has promised a 10-year plan for the NHS in ‘the Spring’ when we can be sure that many of these issues will be tackled.
2025 Government mandate Published in January 2025, the DHSC published what it has called a ‘mandate’ for reform of the NHS,3
which is likely to be the forerunner of the
10-year plan. The Health and Care Secretary of State, Wes Streeting writes in the foreword that the NHS must learn to live within its means. The government’s investment in the NHS, against a challenging economic and fiscal backdrop, must be matched with reform to the operating model, with a sharp focus on improving efficiency and
productivity. One wonders whether sanctions will be imposed when the 10-year plan is published for Trusts and Integrated Care Boards that do not manage to stay within budget. The mandate identifies that during the next
financial year (25/26), the first steps to reform will be taken to be followed by the remainder of the 10-year plan. After the publication of the 10-year plan, the government will update the current mandate to support longer term planning in the NHS, together with a long-term vision for the NHS. The DHSC says that the three key themes of hospital to community, sickness to prevention and analogue to digital will help with other main objectives, which are: l To cut waiting times for care. l Reduce the amount of time spent in ill health. l Tackle health inequalities. l Reduce lives lost to the biggest killers – cancer, cardiovascular disease and suicide. l Make the NHS sustainable in the long term.
The mandate states that alongside the health mission, the government’s growth mission is
April 2025 I
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