A report from the Health Foundation has found that moving care from hospitals into the community improves patient satisfaction.
However, there is not enough evidence on the potential savings that can be made from moving care into a community setting and little evidence of the necessary systematic decommissioning of hospital care. “Getting out of hospital?” reviews the evidence concerning the relative efficacy and cost-effectiveness of community-based treatment regimes. In particular, it focuses on the evidence for shifting acute inpatients. Commenting on the report, Stephen Thornton, chief executive of the Health Foundation said: “Rethinking traditional patterns of where and how care is delivered will be fundamental in addressing the dual challenge of delivering better care that patients prefer while controlling costs. We need to bite the bullet and close wards and we need to prepare and scale up out of hospital care which is hugely fragmented.” The report states that community-based services can, under the right conditions, provide a quality of care as good as that in hospital and, in some instances, at a lower cost. The research also found that successfully implemented projects that moved care into the community tended to be part of a more strategic plan to deliver service improvement. The report points to the promotion of early discharge for patients that do not need intensive acute help but who are not ready to look after themselves as having the most potential to save the NHS money through moving care. However, for significant cost savings to be realised inpatient services need to be reduced or decommissioned once the new service has been set up. Unfortunately, there is little evidence of this systematically happening in practice.
