Barriers still stand in way of moving care out of hospitals and closer to patients' homes

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Despite being a key strand of government policy, the implementation of the shift of care closer to home remains patchy and there is confusion about the benefits it will achieve and the impact it will have on traditional patterns of hospital-based care. That is the conclusion of report about shifting the balance of health care to local settings published today by The King’s Fund.

Shifting the Balance of Care to Local Settings: The SeeSaw report is based on the findings of a simulation exercise led by The King’s Fund in partnership with Loop2 and commissioned by the Department of Health. It identifies the barriers that are currently standing in the way of change and explores what would need to happen to encourage a faster and more consistent shift of care to community settings and patients' homes, where appropriate.

The report argues that leaders within the health service and national and local government need to not only make the case for reform clear but also demonstrate the benefits to a sceptical public. It warns of the risks of focusing too much on buildings and of underestimating the amount of care that patients can receive at home. It also outlines how current incentives in the health service support and reward health care providers who maintain the status quo, rather than those who innovate, diversify and change.

Co-author of the report, Sarah Harvey from Loop2, said:

'As well as delivering care 'closer to home' there is great potential to offer more care in people's homes. This may well be the most cost-effective way of improving outcomes for people needing care. This will require health, social care and housing services to develop even closer working relationships than exist currently. But there is a limit to what exhorting people to 'work in partnership' can do – there is a need for something more deliberate and formal to remove the barriers to integrating these services.

'The NHS' dialogue with the public about care closer to home is often partial and defensive and does not adequately explain the advantages to patients of these new patterns of health care. Unfortunately the public often believe that NHS restructuring is driven solely by financial concerns and not in order to improve patient care. We should not be surprised if they remain sceptical.

'We need to have commissioners with a much higher level of analytical skills to commission multiple pathways of care in local settings but equally, we need commissioners to become much more sophisticated and adept in engaging with their public in a deliberative and convincing way.

'In the end, it may be informed and empowered patients demanding access to personalised care in local settings that will drive widespread moves to deliver care closer to home – but that tipping point won’t be reached if the NHS is unable to communicate the rationale for service changes to the public.'

Niall Dickson, Chief Executive of The King's Fund, added:

'At the moment it can be difficult for commissioners to shift more care to community settings when the incentives for change are not in place. But commissioners must get a more sophisticated grasp of the levers they can use to encourage providers to provide care differently.'

The report also calls for better and more systematic use of technology that can help deliver care in the home as well as noting that there are real risks that the current clinical workforce and the way it is trained could also act as a constraint rather than an enabler of more care being delivered in community settings.

Read the report: Shifting the Balance of Care to Local Settings: The SeeSaw report

Notes to editors

  1. Shifting the Balance of Care to Local Settings: The SeeSaw report by Sarah Harvey and Laurie McMahon is published on Thursday 19 June.
  2. For further information or interviews, please contact The King’s Fund media and public relations office on 020 7307 2585, 020 7307 2632 or 020 7307 2581. An ISDN line is available for interviews on 020 7637 0185.
  3. SeeSaw is the name given to a simulation-based project led by The King’s Fund in partnership with Loop2, and commissioned by the Department of Health’s Shifting Care Closer to Home policy team. Its purpose was to better understand how a shift in care from hospital to community settings could be achieved. The title SeeSaw was chosen to reflect the fact that increasing the level of care in community settings will require a reduction in the volume of care undertaken in hospitals.
  4. The behaviour simulation involved 70 participants – all health care professionals who were asked to take a position in the simulation that mirrored their own so that their behaviour and decisions were accurately informed by their real-life insights and experiences. The exercise included, among others, representatives of SHAs, PCTs, Monitor, the Healthcare Commission, ambulance and paramedic services, practice based commissioners, a patients’ panel and a mental health trust. The simulation explored two time periods – 2008/9 and 2012/13.
  5. Loop2 is a catalyst consultancy established in 2006 by Laurie McMahon and Sarah Harvey. As well as unrivalled expertise and experience in designing simulations and development games, Loop2’s work focuses on helping organisations, partnerships, teams, groups and individuals understand, shape and respond to the complex worlds in which they operate. Loop2 supports clients in setting challenging goals and in developing sustainable solutions and behaviours to keep them on track. For more information go to:
  6. The King’s Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through funding. We are a major resource to people working in health and social care, offering leadership development programmes; seminars and workshops; publications; information and library services; and conference and meeting facilities.