Earlier this year the Prime Minister confirmed that £3.7 billion would be spent on 40 new hospitals in the biggest hospital building programme in a generation.
Yet recent developments in health and social care have seen the NHS take steps to significantly reduce the number of people who go to hospital for treatment and care. The NHS England’s Five Year Forward View, published last year as a blueprint for the future, sets out plans for the reconfiguration of health services towards care in the community and away from hospitals.
Why is this? As always, money matters. Hospital care is expensive, and currently accounts for more than half of all NHS spending. The NHS, like publicly-funded health services around the world, is struggling to meet growing demand while receiving less funding, in real terms. This is a trend that is unlikely to change in the post COVID-19 world. Access to care in hospitals is another challenge. In the UK, many hospitals are in locations that are increasingly difficult to reach and far from where patients actually live and work.
Sir Simon Stevens, Chief Executive of NHS England, sees the traditional divide between primary care, community services, and hospitals – largely unaltered since the birth of the NHS – as a barrier to the personalised and coordinated health services patients need. Long-term conditions such as diabetes or cardiovascular disease are now a central task of the NHS; caring for these needs requires a partnership with patients over the long-term rather than providing single, unconnected episodes of care which traditionally were dealt with in hospital.
When it comes to shifting care from hospitals to the community, technology is an ally. This is a golden age for innovation in healthcare. It is becoming much easier for care to be delivered at home and in the community because healthcare technology is becoming cheaper, more effective and portable. Fewer patients need to go to hospital for chemotherapy, which can now be delivered safely in the comfort of one’s home. Pulmonary rehabilitation in the community can reduce the need for patients with COPD to receive treatment in hospital. Remote monitoring is helping older people to remain independent for longer, providing data that is more accurate and sensitive to change while being less intrusive for users.
Examples of good practice exist around the country. In Airedale, nursing and residential homes are linked by secure video to the hospital, allowing consultations with nurses and consultants around the clock for everything from cuts and bumps to diabetes management. Emergency admissions from these homes have been reduced by 35 per cent and A&E attendances by 53 per cent. In Kent, 20 GPs and almost 150 staff operate from three modern sites providing many of the tests, investigations, minor injuries and minor surgery usually provided in hospital.
These approaches seem to improve the quality of care and patients’ experience. They also deliver better value for money; some may even cut costs. They need to become more widely available across the UK. The NHS is to find a funding model that enables care to thrive in the community while ensuring that hospitals maintain services. But perhaps the biggest challenge will be to persuade taxpayers that having a brand-new shiny hospital near you is not always the best option.
By Martin Barrow
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