Research by the NHS Confederation, examining the potential of increased targeted investment in community services, finds that greater investment of health service budgets into community healthcare services has significant potential to reduce hospital admissions and bring more savings to the wider NHS, most notably in acute care.
The figures show that for every £100 spent in the NHS community care sector, delivering care to patients closer to and in their own homes, there is a £131 (31%) return on investment, representing a net saving of around £26m per year for an average-sized Integrated Care System. This reflects fewer hospital admissions and a reduction in ambulance journeys taking patients to hospital.
The findings demonstrate how areas of the country that spent relatively less on community care in terms of population need have also seen, on average, higher levels of hospital and emergency activity, compared to those spending relatively more.
Specifically, those of the 42 Integrated Care Systems that invested more in community care saw 15% fewer non-elective patient admissions and 10% fewer people being taken to hospital in an ambulance per year. Those systems also saw lower average activity for elective patient admissions and A&E attendances.
This latest report in a series of research commissioned by the NHS Confederation (conducted by Carnall Farrar), examines in detail how investment in community care services in England is currently distributed, and the ‘significant potential’ an increase in targeted investment in community service provision could reap.
Matthew Taylor, Chief executive of the NHS Confederation says: “This analysis shows what we have long suspected - that investing in community services not only helps to reduce hospital admissions and demand on ambulances, but that it also saves the NHS money.
“Successive governments have long held the ambition to shift more care out of hospitals and into the community, but this has never fully materialised. With NHS budgets under huge strain, this analysis shows why it is so important to finally deliver on this long-held ambition. It’s not only better for patients to be treated in or closer to their homes, but it’s also better for the taxpayer.
“This transition can’t happen overnight and there would need to be a period of double running before we could expect to see spend in the acute sector come down. But if we are going to place the NHS on a more sustainable footing over the long term, then this is exactly the type of shift in resources that we need to deliver.”
Ben Richardson, Managing Partner at Carnall Farrar adds: "Our work shows that community services should be treated as the key to unlock system productivity and reduce pressure on the acute sector.”
The starting point for this should be prioritising, standardising and incentivising community data collection, and using that to develop a standard offer in every ICS detailing what the population can expect.”
The report makes a series of recommendations to national government, NHS England and local leaders. These include:
• Prioritising community spend as a mechanism for reducing long-term pressure on the acute sector, as a crucial contributor to healthcare system productivity and as a direct lever to providing improved patient care.
• The need for a recognition that additional central government investment in community care will be required, and that systems should be afforded a minimum of two years to double run with the acknowledgment that as systems shift to an emphasis on more preventative, upstream care, the return on investment will not be immediate.
• Incentivising investment in community care through appropriate payment mechanisms, as a means of reducing long-term pressure on the acute sector especially as winter approaches. This should include developing approaches to tackle the community backlog in a similar way to the elective one.
• The development of a clearer definition of community care, including what it is, what services fall under its remit, and where there are gaps between statutory and non-statutory services.
• Prioritising data gathering that better informs the value of community services, including its funding, spending, demand, activity, availability, access, quality, and impact.
‘Unlocking the power of health beyond the hospital: supporting communities to prosper’ builds on the findings from previously commissioned NHS Confederation research reports. Read/download the full report here.
