Moving care out of hospital won’t save money, experts warn

Schemes that deliver healthcare closer to home are often better for patients but largely fail to save the NHS money according to an extensive review of the evidence published by the Nuffield Trust today. Moving care out of hospital is at the heart of the NHS’s national and local plans to solve its financial problems, but the review suggests that the 44 local plans will struggle to reduce overall numbers of patients requiring hospital treatment unless they are given additional money and staff to develop new services.

Out-of-hospital care is often better for patients and is the right aspiration for the NHS given the growing and ageing population. But it is not likely to be cheaper for the NHS in the short to medium term.
Candace Imison, Director of Policy, Nuffield Trust

The Nuffield Trust’s review explores the existing evidence for 27 of the most common initiatives to move care out of hospital – from GPs having direct access to diagnostic tests, to the use of ‘virtual wards’ to support patients in the community. The review finds that many of the initiatives explored have the potential to improve patient outcomes and experience, but only seven of them were proven to save money. Many of the schemes delivered no overall savings and in a minority (six schemes), the evidence reviewed suggested that they were likely to increase overall costs on the NHS. 

The seven initiatives that saved money included: additional support to people in nursing homes; better support at the end of life; and giving GPs better access to specialist expertise like dermatologists. The schemes that were successful targeted particular groups of patients (such as those in care homes), actively involved patients in their care, supported and trained staff, and targeted a gap in services. 

The six initiatives that led to increased costs on the NHS were: GP extended hours, NHS 111, urgent care centres including minor injury units, consultant clinics in the community, GPs with a special interest, and referral management centres. Common reasons that they increased costs were because they uncovered unmet need, resulted in new demand on NHS services or duplicated hospital services in the community. 

Candace Imison, Director of Policy at the Nuffield Trust and lead author of the report said:

“This evidence review reveals just how tough the challenge is for the new Sustainability and Transformation Plans currently moving towards implementation across England. Out-of-hospital care is often better for patients and is the right aspiration for the NHS given the growing and ageing population. But it is not likely to be cheaper for the NHS in the short to medium term – and certainly not within the tight timescales under which the STPs are expected to deliver change.  

“The wider problem remains that there isn’t enough money in the system both to invest in these schemes and to pay for the hospital care of thousands of extra patients every year. 
“In the context of the tight squeeze on primary and community care and the workforce crisis across the NHS, policymakers need to support STPs to invest in out of hospital care. And that will mean accepting that the system needs the time, money and space to innovate and experiment with new services. For their part, STP leads must be honest about what works and focus relentlessly on it.”  

The Nuffield Trust’s review, Shifting the balance of care: great expectations, analyses numbers of patients using hospital services over ten years, and the assumptions contained within the STPs to reduce hospital activity. The report finds that some STPs are targeting up to 30 per cent reductions in some areas of hospital activity, including outpatient care, A&E attendances and emergency inpatient care over the next four years.