This project aims to understand the impact of Covid-19 on community services use and consider how this might change over time.
Three research questions have been identified:
- What community services were used by adult patients discharged from hospital at the start of the pandemic to free up acute capacity?
- What community services were used by adult Covid-19 patients who had been discharged from hospital?
- What are the implications for demand for community services in the future?
Why are these questions important?
Community services provide care and treatment outside of hospital to patients with ongoing and complex needs. Prior to the Covid-19 pandemic, community services were identified as being critical to the delivery of integrated care.
At the start of the pandemic, the importance of community services was reinforced in guidance on discharging patients from hospital in order to free up beds for Covid-19 patients. Community services are also critical to meeting the needs of patients who are recovering from Covid-19.
However, very little is known about what community services are provided and to who, either before the pandemic, or now. There are long-standing issues with data availability and quality of data, and although there is now a national community services data flow, there are still significant gaps in the coverage and completeness of data. We propose to link community data and inpatient data to enable us to understand the characteristics of patients who received services in the community, and the nature of these services.
We will focus our analysis on two cohorts of patients in particular. First, patients who were discharged from hospital in March and April 2020 to free up beds as the NHS prepared for Covid-19 admissions. And second, patients who were treated in hospital for Covid-19, many of whom have rehabilitation needs and ongoing health problems.
Understanding what has happened in the community to both of these cohorts of patients will be important for planning future waves of the pandemic, and understanding the resources needed to provide care for patients as they recover from Covid-19. Given the anticipated difficulties of providing services within hospitals, due to physical space constraints, understanding community provision better is only going to become more important. For example, the approach to discharging patients in March and April may provide lessons for reducing the number of long-stay patients in acute beds in the future, and for the ongoing discharge to assess policy.
In summary, the project will address a gap in our understanding of community services and the response to Covid-19.
We will link hospital inpatient data and community services data for this project (using pseudo anonymised patient identifiers provided by NHS Digital). The two cohorts of patients – those discharged at the start of the pandemic, and those who had Covid-19 - will be identified from the inpatient data. We will then link the information about their inpatient care to data on services used in the community.
From this linked data we will describe use of community services for our two cohorts of patients in the months after discharge. Where possible we will also look at equivalent groups in 2019 as comparators.
Because of concerns about the quality of community data, we will limit our analysis to areas which have had consistent data quality over time. The analysis will be undertaken at an area level to enable us to assess differences in the populations covered by the analysis compared with the England population, and potentially to produce national estimates.
The Nuffield Trust will publish the results of the analysis. The exact form of outputs will be reviewed as the project progresses, but are likely to be short research reports or briefings. We may also publish blogs or other outputs during the course of the work, such as the analysis already produced of people discharged in March 2020.
The outputs will make a significant contribution to understanding community service provision, an area where there is currently a significant knowledge gap. The project will produce insightful analysis of future demand for community services, both for Covid-19 patients and for discharged patients generally. In addition, the project will develop methods for analysis of community services data, and a greater understanding of what is feasible within the limitations of current data quality.
The project aims to complete by April 2021. Timescales will be kept under review as the project progresses.