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System-wide change with more care out of hospitals needed to meet challenges facing the NHS

Reserving inpatient care in major hospitals for people with life-threatening conditions or those needing complex surgery could be more clinically effective and make better use of NHS resources, according to a new report by the NHS Confederation.

The report argues that only a system-wide change which sees new commissioners and service providers collaborating for the benefit of the local health economy will help the NHS meet the significant challenges it faces.

This should go hand-in-hand with the development of more health services delivered in the community and in people's own homes, it says. Transforming local care, a new paper from the NHS Confederation's Community Health Services Forum, says there is an emerging consensus that limiting larger hospitals' care to specialist treatment for the acutely ill could significantly improve both patient experience and clinical outcomes, as well as make the NHS more efficient.

It argues that the NHS and the public need to shift their 'default setting' for delivering healthcare from hospitals to the community and the home where it is in the patients best interests. It demonstrates a number of examples where providers of community services are already transforming care delivery and says they should be allowed to go even further.

The NHS Confederation is calling on the Government and the NHS Commissioning Board to facilitate the necessary change by ensuring health and social care funding supports the transfer of care into community settings. Development of payment systems that reward prevention, early intervention and integrated working, as well as reinvestment of efficiency savings to support community-based service delivery, could transform the quality and sustainability of health and social care services.

Jo Webber, interim director of policy at the NHS Confederation, said:

"Changing how we think and respond to circumstances is never easy, but never before has the scale of change required been like that currently facing the health and social care system.

"For too long, the default setting when we think about health care or support is to think of a hospital. But in reality, acute hospitals - whether major teaching sites or local district generals - are rarely the best place for someone who needs ongoing health or treatment. There are already groundbreaking services in place in some parts of the country, which are transforming patient experience and quality of care, as well as contributing to making the NHS more efficient overall. It is time we started thinking differently right across the country, and making sure investment supports innovative service delivery that supports patients' independence and recovery."

The report demonstrates the benefits of community-based service delivery in a range of case studies from across the UK, including:

 - Development of a 24-hour access process for community health services, reducing emergency hospital admissions. A team from Birmingham Community Healthcare NHS Trust delivers rapid response and advanced assessment within two hours of an urgent referral to its single point of access, as well a multi-disciplinary response for non-urgent referrals.

 - Community-based rehabilitation programmes to help break the 'admission, loss of independence, re-admission' cycle, such as Norfolk Community Trust's Early Supported Discharge team, which provides intensive post-acute rehabilitation for stroke patients, allowing them to return to their own homes rather than a nursing home.

 - Assistive technology or 'telehealth', which allows patients with long-term conditions to have their vital signs monitored by clinicians without needing to leave their home. A scheme in Liverpool saw a 73 per cent reduction in emergency hospital admissions for acute coronary syndrome.

The full report is available here.

Notes to Editors

1.    The NHS Confederation represents all organisations that commission and provide NHS services. It is the only membership body to bring together and speak on behalf of the whole of the NHS. We help the NHS to guarantee high standards of care for patients and best value for taxpayers by representing our members and working together with our health and social care partners.

We make sense of the whole health system, influence health policy and deliver industry-wide support functions for the NHS.

2.    Follow the NHS Confederation press office on Twitter @NHSConfed_Press

3.    A full list of NHS Confederation press releases and statements can be accessed on our media page

4.       Contact Francesca Reville on 020 7799 8633 or Georgie Agass on 020 7799 8637. For out of hours media enquiries, please call the Duty Press Officer on 07880 500726


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