Moving healthcare away from hospitals

The new government has given a strong signal that they are going to continue the move of healthcare away from hospitals. There is, as yet, no definitive policy announcement but it seems that a shift of emphasis and resources towards the community and primary care is soon to take place. This will be a fundamental change to the structure and function of health services and is a far from simple development. In the forty years since this author began working in health, every government without fail has attempted to strengthen and promote health and well-being without very much success. The ambition to change the focus of health from illness management to wellness and prevention has not been found to be achievable — but perhaps this time, it will be different.

The King's Fund's Making care closer to home¹ cites a number of reasons why the focus has not been successful, and these include a lack of agreement about the purpose underpinning the vision for the health and care system. They suggest that the reasons for this disparity are:

As we know, the health and care system is infinitely complex with many interconnected elements, but to achieve a wholesale shift in emphasis is hugely complex, costly and will take a great deal of effort over a long period of time. The objective would be to improve healthcare outcomes for all patients and users and to deliver an improved level of care and experience to everyone who uses the services. The change cannot be about short-term gain and cost savings which many previous developments have been focused on, but requires a complete change to the way we think about health and wellbeing.