Loss of out-of-hospital capacity undermining NHS care for local patients

15 December 2016

A new survey has found that the NHS’ ability to cope with rapidly rising demand is being undermined by reductions in the number of beds and other services in the community that are vital for helping patients avoid the need for hospital treatment.

This is despite a clear vision, set out in NHS England’s much supported Five year forward view, published in October 2014, to deliver more care outside of hospitals, with services integrated around the needs of patients. The underlying assumption is that out of hospital capacity is steadily being expanded in line with the Five year forward view, supported by the Government’s Better Care Fund. 

The survey found significant reductions in the numbers of beds in the community because of reductions in capacity, a lack of funding and staff shortages.

The survey indicates that in many local health systems out of hospital capacity, including social care, is actually being reduced, not increased. The survey of the leaders of England’s hospital, mental health and community trusts was carried out late last week and published today by NHS Providers. 109 chief executives, chief operating officers and finance directors from 97 NHS trusts responded to the survey – this represents more than 40% of all hospital, mental health and community trusts in England.

The survey found significant reductions in the numbers of beds in the community because of reductions in capacity, a lack of funding and staff shortages.

More than half (52%) of respondents said it had become more difficult to deal with demand for community-based services over the last two years. These so-called ‘intermediate care’ services are vital in helping patients who no longer need to be in hospital but who need more support to recover, for example by receiving extra nursing care to help them return home shortly after. They also provide short-term nursing help to prevent people needing to go to hospital in the first place.

Respondents said there is growing demand for ‘intermediate care’ services in their local communities, and that the increasing numbers of people who now need care have more complex conditions and require more intense support than in the past.

The survey outlined a number of examples of where NHS trusts are working effectively with GPs, care homes and others to ensure patients benefit from more joined-up care. But it also highlights the challenge the NHS faces in trying to offer more care for patients and service users outside hospital and closer to home at a time when social care and other community based services are being pared back. When asked whether reinstating the lost beds and services would enable trusts to meet the demand they faced, most respondents said it would only go some of the way and that transforming services is more critical.

Responding to the survey, the director of policy and strategy at NHS Providers, Saffron Cordery, said:

“The vision for providing more care out of hospital is the right one. But just at the point when the NHS desperately needs more capacity outside of hospitals, we seem to be going backwards in many places. The NHS had assumed that vital out of hospital capacity was being expanded. In fact, in many areas, it is reducing.  

just at the point when the NHS desperately needs more capacity outside of hospitals, we seem to be going backwards in many places.

“It is deeply worrying that more than half of NHS trusts said they were less able to meet demand than two years ago due to more people needing care at the same time as reductions are being made to beds and other services that are vital for keeping people out of hospital.

“Trust leaders are telling us this is undermining their ability to deliver care for local patients. These findings help explain why A&E departments are under such intolerable strain.

"The NHS is doing all it can to cope with rapidly rising demand but we need proper investment in care provided beyond hospitals. Patients should be looked after in the right setting: one which is as safe, comfortable and convenient as possible. They deserve better.

“We were disappointed that there was no additional funding for social care in the recent autumn statement. Along with many others, we had argued that targeted investment in this area would benefit the wider NHS. We hope this oversight will be addressed meaningfully when funding for local government is announced later today.”

Our recent report, The State of the NHS Provider Sector, shows how trusts are developing successful new approaches to deal with growing demand. It cites examples of trusts collaborating with local authorities and directly employing social care workers to allow patients to be discharged into the community.

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