Healthcare delivery
Moving healthcare away from hospitals
Kate Woodhead RGN DMS discusses the drive to ‘make care closer to home’ and move healthcare away from hospitals where possible. A shift in focus from illness management, to wellness and prevention will be a key aspect of the Government’s ambition – so how can this be achieved?
The new government has given a strong signal that they are going to continue the move of healthcare away from hospitals. There is, as yet, no definitive policy announcement but it seems that a shift of emphasis and resources towards the community and primary care is soon to take place. This will be a fundamental change to the structure and function of health services and is a far from simple development. In the forty years since this author began working in health, every government without fail has attempted to strengthen and promote health and well-being without very much success. The ambition to change the focus of health from illness management to wellness and prevention has not been found to be achievable – but perhaps this time, it will be different. The King’s Fund’s Making care closer to home1
cites a number of reasons why the focus has not been successful, and these include a lack of agreement about the purpose underpinning the vision for the health and care system. They suggest that the reasons for this disparity are: 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 inequalities.
As we know, the health and care system is infinitely complex with many interconnected elements, but to achieve a wholesale shift in emphasis is hugely complex, costly and will take a great deal of effort over a long period of time. The objective would be to improve healthcare outcomes for all patients and users and to deliver an improved level of care and experience to everyone who uses the services. The change cannot be about short-term gain and cost savings which many previous developments
have been focused on, but requires a complete change to the way we think about health and wellbeing. Much of the continuing focus will have to be
on developing policies and strategies which enable the consistent vision. Hospital workforce and management will need to experience community-based care and be able to integrate the service towards their new understanding. This will need to re-educate many present staff to a new way to deliver health and care. Management too will need to change their view away from the acute sector and focus clearly on community-based care. The Integrated Care Boards (ICBs) have an opportunity to do this, partnering as they do with local authorities and voluntary organisations, that are all included under the community umbrella. Services which may also be included in the ‘new’ approach may be optometry, local pharmacies and dental services. One of the specific purposes of the ICBs is to reduce health inequalities – which have received many headlines this past few years. This too, as it is such a serious issue, should be a focal point of the community-based approaches to healthcare.
Community centred practice There has been a movement for community- based health developments for many years and many of the reports and research emerged around 2015. It will remain to be seen whether the new government uses the expertise from that time or has to re-invent the wheel. Community-based approaches are not just based in the community; they are also about mobilising energy within communities, promoting equity and increasing people’s ability to focus on their own lives and health. Four different strands that have been described in the past2
are:
1. Strengthening communities – where approaches involve building on local capacities to take action together on health and social determinants of health.
2. Volunteer roles – where the approach focuses on enhancing individuals’ capabilities to provide advice, information and support or organise activities around health and well being in their or other communities.
3. Collaborations and partnerships – where approaches involve communities and local services working together at any stage of the planning cycle, from identifying needs
October 2024 I
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