The challenges facing the NHS require a fundamental change in how care is delivered. The government says we need to focus our collective efforts on three key shifts: moving care from hospitals to the community, embracing digital transformation, and shifting from treatment to prevention. The findings of Lord Darzi's investigation echo this, and describe the need to hardwire these changes into the system through, for example, aligning financial incentives with these new priorities.
By delivering more care in the community and people's homes, and through prevention and earlier intervention, the NHS can better manage rising demand driven by an ageing population and growing levels of ill health. Expanding our digital and technological capacity, alongside broader capital investment to repair and modernise the estate, will be needed to deliver this "left shift" in care. Taken together, these changes have the potential to improve patient outcomes and experiences and are key to long-term financial sustainability.
The good news is these shifts are already underway, ensuring people receive the right care, in the right place, at the right time, with NHS trusts at the forefront. And with a national approach aligned to support and enable them, trusts can go even further.
How trusts are leading these shifts
Trusts providing acute services like East Lancashire Hospitals NHS Trust (ELHT) have experienced increased demand in their A&E departments. ELHT has been strengthening its community teams and focusing efforts on driving forward a ‘home first’ approach, easing pressure on urgent and emergency settings and ambulance conveyances. Its Intensive Home Support Service (IHSS) offers a 24/7, year-round service via a direct phone line, assessing individual needs to determine any required care plan. In 2022, the IHSS initiated a 'front door' service in its emergency pathways which allows staff to identify patients well enough to receive care at home and avoid further waiting in the emergency department.
Similarly, Walsall Healthcare NHS Trust, working with the Walsall Together partnership, has various community-based initiatives across the whole care pathway. This includes a care navigation centre which allows people to speak to the right professional first time, and urgent community response teams which deliver care rapidly in a person's own home. The trust also has an integrated front door team within the emergency department, predominantly made up of experienced community-trained clinicians who play a vital role in preventing unnecessary admissions.
Hampshire and Isle of Wight Healthcare NHS Foundation Trust has targeted preventative actions in housing. Since 2021, the trust has employed clinicians within local authority housing teams to support appropriate housing offers, with the aim of encouraging patients into independent long-term living, targeting those in earlier stages of illness and avoiding admissions. The trust has also created a supported accommodation pathway out of mental health inpatient settings, alleviating pressure within services.
Another trust providing mental health services, North Staffordshire Combined Healthcare NHS Trust, has developed a crisis care centre at its Harplands Hospital site in Stoke on Trent. The centre brings together a range of teams offering services to people of all ages throughout the year, providing support for anyone who feels they are in distress or in need of advice or reassurance. The trust is also doing valuable work 'upstream' on the mental health crisis pathway, encouraging self-management of mental health issues and working alongside community programmes to get people the right support.
Hertfordshire Community NHS Trust has been working with system partners to achieve a shift to prevention and proactive care using data and digital technology. Since 2022, the trust has developed a Hospital at Home service which has helped more than 13,000 patients receive care in their own home. The core team is made up of a range of health and social care professionals who provide a hybrid service of remote care from an Integrated Care Coordination Hub and face-to-face care in an individual’s home.
What more is needed?
The 10-year plan for health offers a unique opportunity to ensure the right care is delivered in the right place and at the right time.
These compelling and innovative programmes show the potential and readiness to scale up the shift to a more preventative, holistic and community-based model of care. Our Providers Deliver report calls for a supportive operating environment to enable this.
As part of a national commitment to taking these changes forward, there needs to be a sustained focus on ensuring equitable access and patient-centred approaches. And a long-term approach to the enablers too: multi-year funding settlements, clear national prioritisation, capital investment commensurate with the challenge, and staff supported to innovate and continuously improve.
We also need to see long overdue reform of the social care sector, and recognition across the breadth of public services of their key role in determining health, as part of that push towards improved prevention.
This blog was first published on HSJ.
About the author
