The health needs of the population are changing; people are presenting with more acute and more complex care needs. The UK has an ageing population, bringing with it distinct health and social care challenges (Age UK, 2024). Persistent health inequalities have exacerbated demand for services and stalled or even reversed progress in improving health outcomes, with declining rates in healthy life expectancy recorded over the previous decade (BMJ, 2024).
The UK compares badly with other countries for health outcomes – demonstrated in higher avoidable mortality rates – and the situation is getting worse (The King's Fund, 2023). The Health Foundation has projected that by 2040, 9.1 million people will be living with major illness, an increase of 37% (The Health Foundation, 2023). NHS services are already struggling to keep pace with changing levels of demand – a recent survey by NHS Providers found 82% of trust leaders do not believe they have the capacity to meet current demand for children and young people’s services (NHS Providers, 2024a).
The health and care sector will need to adapt so that it can provide the most appropriate support to best meet these changing patient needs. The Labour government has outlined three key shifts as part of its commitment to build an NHS fit for the future: from 'hospital to a primary care and community service', from 'analogue to digital' and from 'treatment to prevention'.
The shift towards greater delivery of care in the community, through technology and innovative ways of working, and with a meaningful focus on prevention, is much needed, and we welcome the calls to develop a 'neighbourhood health service'. For many people, receiving care in a hospital is not the most appropriate setting for their needs. Instead, they could be better supported in, or closer to, their own home. Ensuring people are able to receive the right care, at the right time and in the right place has been the longstanding strategic intent for the health and care sector.
The drive to deliver more care in the community is reiterated in the recent report by Lord Darzi (Darzi, 2024). He highlights the importance of having a more joined-up approach to care provision, delivered in local communities. This is not only better for individuals, but also helps alleviate pressure across the wider system, including urgent and emergency care (UEC) pathways and lengthy waiting lists.
A recent report by Age UK shows that significant numbers of emergency hospital admissions of older people could have been avoided if they were supported earlier, before their health deteriorated to crisis point (Age UK, 2024). This is true across a range of clinical conditions and service users, including those with mental health needs who could be better supported in the community at an earlier stage. Providing more preventative and person-centred health and social care results in better outcomes for individuals and improved patient flow across the wider system. It is therefore vital that national policy makers make good on their commitment to delivering more care in the community by ensuring funding follows ambition.
This report looks at several case studies which highlight just some of the successes trusts are having to enable people to access and receive the care they need in the right place at the right time.
Tackling the wider determinants of health to improve patient flow
Hampshire and Isle of Wight Healthcare NHS Foundation Trust has identified housing and community inclusion as key areas that impact the mental health and wellbeing of its patients. It has set up a number of new approaches to take preventative action in these areas, including providing supported accommodation pathways to improve flow out of inpatient settings, embedding early intervention within local authority housing teams, and employing Citizens Advice case workers on hospital wards.
Reducing demand in emergency care by providing support at home
Over the last few years, East Lancashire Hospitals NHS Trust has been strengthening its community teams and focusing efforts on supporting patients in their own homes, easing pressure on emergency departments and ambulance conveyances. The 'home first' approach is at the heart of a coordinated response to stop unnecessary admissions and support the earliest possible discharge of every patient.
Improving mental health crisis care from the ground up
Following a £1.1m investment in 2018, North Staffordshire Combined Healthcare NHS Trust developed a crisis care centre, which brings together a range of teams offering services to people of all ages throughout the year, offering an accessible service for anyone who feels they are in distress or need advice or reassurance. The trust has also been working 'upstream' on the mental health crisis pathway by reaching out into the community and linking people through to the right service.
Harnessing a culture of continuous improvement to deliver care in the right place
Leaders at Walsall Healthcare NHS Trust cite the culture of improvement and collaboration across the trust and wider system partners as a crucial enabler to providing the right care in the right setting. Staff have a real appetite to improve care at every stage of the pathway and are encouraged to refine their approach to ensure people are receiving the best possible support in the most appropriate place. This helps drive the development of new ways to help keep people well at or closer to home.
Identifying and preventing need in the community
Building on the work of their Hospital at Home service, Hertfordshire Community NHS Trust is looking at how it can provide more proactive support for individuals through targeted interventions within its 'Minus nine' project. The project aims to identify the need and intervene for patients approximately nine days before a hospital
admission or crisis intervention. To do this, the trust will look to identify the highest risk patients across the system and aim to provide wrap-around care at an earlier stage. Rollout for the project is planned for winter 2024/25.
This report shares some of the approaches trusts have taken to deliver more care in the community, innovating in a challenging operational context. Trusts will continue to develop fresh, forward-thinking initiatives to support people at, or closer to, their own home, and at an earlier stage of their illness.