Research report
26 Jun 2013

The Nuffield Trust has undertaken evaluations of over 30 community-based interventions designed to reduce emergency hospital admissions. This report presents the key learning from these studies.


The NHS is encouraging more innovation in service delivery, in part to reduce avoidable ill health and demand for care, particularly for people with long-term and/or multiple conditions.

Many of these interventions operate in community settings and aim to curb the growth in emergency admissions. For example, in May 2013, the Department of Health announced it will be appointing a number of new health and social care integration ‘pioneer’ sites by September 2013.

However, despite these initiatives the NHS is experiencing continuing increases in emergency hospital admissions, and recent reviews show there is little systematic evidence of what works in terms of community-based alternatives to hospital admissions.

The Nuffield Trust has undertaken evaluations of over 30 community-based interventions during the past five years, using quantitative methods and summative evaluation.

Our aim is to provide insights from recent service interventions in the NHS which may aid the development of future innovations

In many cases we have been tasked with identifying whether service changes have led to a reduction in emergency admissions and the associated cost to the NHS. However, in most cases we have not found reductions in emergency admissions.

In this paper we outline the key findings from our evaluations and identify nine points that may help those designing, implementing and evaluating such interventions in future.

In particular, it should provide useful learning for the new health and social care integration ‘pioneer’ sites that will be appointed by the Department of Health by September 2013

The community-based interventions evaluations highlighted in the report include:

  • Department of Health-funded integrated care pilots

This report forms part of the Nuffield Trust’s work to develop evaluation methodologies that exploit the large amount of administrative information on individual patients that is available in the NHS and social care.

Find out more information and access all our publications and other resources from our evaluation area of work.

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