Bringing care closer to home

The NHS Institute for Innovation and Improvement has developed a series of products to help health care leaders look at how to deliver effective care in or near patient’s homes, says Martin Samuel, the Institute’s head of the Care Outside Hospital Priority programme

Our Health, Our Care, Our Say, focuses on the importance of patients receiving care closer to home, shifting from a traditional model of hospital based services towards a more adaptive community-based approach. To help make this shift, the NHS Institute for Innovation and Improvement has developed a series of products to help health care leaders look at how to deliver effective care in or near patient’s homes.

Shifting care: not a new concept

The White Paper sets out a vision to provide people with high quality NHS services in the communities where they live.

This concept of shifting care away from a hospital setting is not new and until recently there has been little evidence of systematic and sustained shifts taking place. Clinicians and managers have seen the potential benefits of redesigned, community-based services for many years. In some cases service developments were implemented and in many cases they were not. Shifting care is a significant challenge for local health communities.

In light of the White Paper, implementing this policy will now be at the forefront of commissioning decisions. Commissioners will be looking increasingly at how care can be shifted in practice quickly and successfully.

Realising the benefits

The NHS Institute’s Care Closer to Home Programme was established in 2005 to explore the scope for bringing about shifts in care within the NHS.

Looking at the number of surgical follow ups that take place in hospital outpatients, the number of avoidable emergency admissions and the number of rehabilitations stays for major conditions, the NHS Institute calculated that if only half of these were transferred, then close to seven million care events could be shifted out of acute care. The cost of delivering this activity currently costs several million pounds

Over the past year, the NHS Institute worked with five healthcare communities across the country testing solutions for shifting care across a wide range of conditions.

The results are now coming to fruition and on November 1 st a series of approaches and products from the NHS Institute will be launched which are designed to help health communities deliver effective care closer to home.

Helping commissioners make the shift

The products will support the steps from strategic prioritisation for population scale change through to practical project delivery .

Shifting care from hospitals to community settings requires a great deal of alignment and coordination from all key stakeholder groups. Those who will benefit from using these tools are:

Strategic health authorities assessing and progressing commissioning plans

Primary care trusts identifying priorities and plans for shifting care

Practice based commissioning groups identifying services to be shifted

Providers of secondary, primary, social care and voluntary organisations aligning with commissioning plans to deliver care closer to home.

Developing the products

Within the five healthcare communities across the country-Birmingham, Derbyshire, Manchester, Stour and Torbay-fourteen projects were identified. Each project looked at shifting care into an alternative setting with an emphasis on making the system fit around the patient rather than the patient fitting in with the system. The resulting key learning from these five sites was then developed into a series of products.

Helping you with your local plans

The products are designed to help staff objectively analyse the most significant opportunities for their local health community and assist in determining local priorities. Furthermore, they enhance the service improvement capabilities of organisations.

The suite of products is available free and online at www.insitute.nhs.uk/careoutsidehospial. The products will be supported by the ‘Making It Happen’ Learning Programme, which will commence in January.

NHS Institute for Innovation and Improvement

T: careoutsidehospital@institute.nhs.uk

Birmingham East and North PCT piloted a community based early intervention service shifting referrals for assessment from secondary care to primary care.

The new service model simplified the patient pathway by implementing a ‘one stop’ approach to assessment and care planning, with participants seeing all members of the multi-disciplinary team on the same day. An individually tailored treatment programme or discharge was then organised.

Over a six-month period waiting times for appointments was reduced from an average of 87 weeks to 22 days. A significant reduction in referrals to secondary care was noted with 95% of patients stating they were satisfied or very satisfied with their experience at the clinic. Furthermore the team estimated that it would cost £604 in sessional costs per 8 people seen at the clinic compared to £2492 in secondary care costs.