Major NHS ambition to shift to community care ‘elusive’ without extra cash

A report released today by the Nuffield Trust has revealed that STPs are working towards “undeliverable expectations”, warning that STP schemes to move care out of hospitals will not work without “significant additional investment” in community alternatives and that the plans are unlikely to save money in the short term.

The research called for NHS trusts to set more realistic expectations for the progress of STPs, suggesting that the current trajectory of the plans could risk them being stopped altogether before they have been given a good amount of time to show their benefits, all due to low staff morale and a failure to meet targets.

The think tank analysed a range of literature concerning STPs and other initiatives that planned to move care out of hospital to work out how realistic aims to save money and improve patient outcomes were.

Similarly to other reports on STPs, Nuffield Trust concluded that although STPs have the potential to improve patient outcomes by bringing their care closer to the community, research suggested that frequently, NHS bodies overstated the economic benefits of these initiatives.

“While out-of-hospital care may be better for patients, it is not likely to be cheaper for the NHS in the short to medium term – and certainly not within the tight timescales under which the STPs are expected to deliver change,” said the report.

The review also suggested that placing additional responsibility on primary and community care at a time when care providers are struggling with rising vacancies in medical and nursing positions, as well as a growing number of GPs practices closing, was a serious challenge – and one that STPs will have to rise to if they are to succeed.

“A further complicating factor is that in-hospital and out-of-hospital care are not on an equal footing when it comes to investment in staffing, infrastructure and the elusive but important issue of prestige,” said the Nuffield Trust.

“And despite the considerable pressures they are facing, hospitals have the infrastructure and payment systems to enable continued investment, while the same cannot be said for care out of hospital. This makes the goal of transferring care out of hospital all the more challenging.”

It also warned that for many of the benefits of health initiatives to be felt, they needed more time to be successful, adding: “The STP process is a case in point here – one of the biggest shifts in how the NHS delivers care for a generation is expected to be completed within five years.”

STPs were also found to be most successful when they targeted particular patient populations in the communities (such as nursing homes of end-of-life care) and improved access to specialist expertise, as well as provided active support to patients and gave staff appropriate and specified training.

Commenting on the work, Nuffield Trust researcher Sophie Castle Clark, who was part of the team who drew up the report, said: “Moving care out of hospitals can deliver holistic, patient-centred care closer to home, improving patient experience.

“But in most cases it is unlikely to deliver savings. In the context of growing activity and an absence of additional resource to support transformation, the long-standing ambition to shift the balance of care from hospital to community may still prove to be elusive.”

Niall Dickson, chief executive of the NHS Confederation, said the think tank report was a timely one “which shows how NHS organisations and their local partners are driving change to bring care closer to people’s homes”.

“There are many encouraging signs from a host of schemes around the country, but it is right to point out that care in the community is not always or necessarily cheaper and that it does require extra resources – including properly trained staff to deliver these new ways of delivering care,” he added.

“The NHS is facing an unprecedented double whammy – manage the pressures while transforming the care. That is a big ask and there is a very real risk that the demand to cut budgets and meet ever rising demand will derail these plans.”

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