Support for providers and commissioners to make evidence-based appraisals of how the benefits compare with the costs of various approaches to move care closer to home.
The Five Year Forward View has encouraged efforts to deliver more healthcare out of acute hospitals and closer to home, with the aim of providing better care for patients, cutting the number of unplanned bed days in hospitals and reducing net costs.
Providers and commissioners considering strategic changes to the way in which services are delivered need to agree what they wish to achieve and understand the range of options. They then need to be able to assess the impact on quality and outcomes for patients and finances for the local health economy of each scheme.
To support this decision-making, we ran a project to examine cases where provision of non-elective care moved from an acute hospital to the community. We then developed the resources below to support the sector in planning new care models. This includes a summary of our findings, details of our analysis, practical tools to support providers and commissioners and a set of case studies on schemes to avoid emergency admissions to acute hospital or to discharge patients more quickly.
Delivering more healthcare services closer to home rather than in acute hospitals is a new aproach being reviewed by the sector. Schemes to do this, when well designed, can help local health economies manage capacity and may help avoid costs in the long run. Find out:
- why we did this project
- what we looked at
- how we analysed the data
- our most important findings and conclusions
Summary (PDF, 523KB, 13 pages)
Literature review of clinical impacts
A summary of evidence on possible quality and outcome impacts for patients of providing care in community-based settings rather than hospital, based on searches in PubMed, life science journals and online books.
Literature review of clinical impacts (PDF, 476KB, 17 pages)
Findings on how 4 types of schemes (to avoid acute hospital admissions or speed up discharge) affect costs in a typical suburban health economy, alongside data on the costs and impacts of these schemes.
Financial impacts (PDF, 1.01MB, 41 pages)
How providers and commissioners have tackled the 5 most frequently mentioned implementation challenges.
Implementation considerations (PDF, 627KB, 20 pages)
NHS talks: why move care closer to home?
Monitor talks to NHS foundation trust staff about their experiences in delivering community-based healthcare schemes.
Discussing the challenges
Hear from NHS staff who have delivered schemes in our online stories, and share your own experiences or questions.
15 case studies that describe schemes to avoid hospital admissions, enable early discharge or reduce length of stay through improving acute pathways.
Case studies by theme
We’ve grouped the case studies by theme so that you can read the ones that are most useful to you and your organisation.
Admission avoidance and length of stay reduction (PDF, 206KB, 13 pages)
Admission avoidance (PDF, 325KB, 35 pages)
Enabling early discharge (PDF, 225KB, 11 pages)
Improving acute pathways (PDF, 253KB, 23 pages)
Case studies: collection of all 15
Download the whole collection of case studies.
Case studies: whole collection (PDF, 601KB, 75 pages)
Individual case studies
Telehealth Hub (PDF, 174KB, 5 pages)
Acute Care of the Elderly Service: Croydon Health Services NHS Trust (PDF, 170KB, 5 pages)
Discharge to Assess: South Warwickshire NHS Foundation Trust (PDF, 213KB, 6 pages)
Midhurst Macmillan Palliative Care Service: Sussex Community NHS Trust (PDF, 177KB, 5 pages)
Single Point of Access: South West Yorkshire Partnership NHS Foundation Trust (PDF, 169KB, 4 pages)
Rapid Response Service: Central and North West London NHS Foundation Trust (PDF, 179KB, 6 pages)
Enhanced Rapid Response Service: Kent Community Health NHS Foundation Trust (PDF, 172KB, 4 pages)
Emergency Ambulatory Care Service: Countess of Chester Hospital NHS Foundation Trust (PDF, 114KB, 4 pages)
Early Supported Discharge Service: Countess of Chester Hospital NHS Foundation Trust (PDF, 106KB, 3 pages)
Emergency Multidisciplinary Unit: Oxford Health NHS Foundation Trust (PDF, 121KB, 5 pages)
Considerations for providers and commissioners
A quick overview of key resources that providers and commissioners can use to be more strategic when implementing different schemes to move healthcare closer to home.
Considerations for providers and commissioners (PDF, 211KB, 1 page)