A document published in 2013 called ‘The NHS Belongs to the People: A Call to Action’ sets out the challenges we are facing in relation to healthcare. It emphasises that with more people living longer and with more complex conditions, increasing costs without increasing resources, and rising expectations of the quality of care, the NHS must change. The comments below are extracted from a longer statement by Sir David Nicholson:
‘The focus needs to shift from buildings and onto patients and services’……’New technology means earlier diagnosis and better treatment, but this costs more and we are not reaching everyone we need to’….’The NHS can increasingly deliver care at home, yet too often patients have to travel to care around buildings.’ July 2013
The national direction has been consistent for a number of years and increasingly focused on prevention and rehabilitation approaches and, where possible, providing care in, or closer to, people’s homes. Much of the early thinking was set out in the Department of Health’s 2008 report, ‘Delivering Care Closer to Home: Meeting the Challenge’:
The demographic profile of England is changing. The proportion of older people is growing and we are living longer, often with long-term health and care needs. For example, a fifth of the population of England is over 60, the over 85s are the fastest growing segment of the population, set to double in number by 2020, and there are expected to be 4.5m people aged over 85 in 2025 (International Longevity Centre).
In England, 15.4 million people have a long-term condition and due to an ageing population, it is estimated that the number of people with at least one long-term condition will rise by 3 million to 18 million by 2025. In this demographic landscape, health and care services that are not actively incorporating measures to provide early intervention and prevention will struggle to cope with future demand.
Less tangibly, but no less significantly, social attitudes are evolving, with growing expectations that services are more responsive and work with users, focusing on their priorities rather than service-defined outcomes.
As the pattern of demand alters and we start to see a greater emphasis on managing and living with long-term needs, compared with the more traditional emphasis on curing disease entwined with a shift towards ‘co-production’ of health and care outcomes, the provision of supportive and enabling care closer to home (including at home) will come to seem normal, and, for many, necessary.
Acute services will still be an absolutely vital part of the pathway, but it will be possible and for many people preferable, for an increasingly large proportion of the care pathway to be situated outside of a hospital setting, making greater use of community urgent care services and of ambulance services, whose potential as a hub and a connector has not yet been fully realised. The potential for new technology, with its mobility, flexibility and rapid transfer of information to support far greater levels of service in home and community settings is real and immense, as we are already starting to see in telecare services, and in the transfer of diagnostic services into the community.
Other publications include:
- ‘Our Health, our care, our say: A new direction for community services’ (2006) – Department of Health
- ‘Shifting Care Closer to Home: Care Closer to home demonstration sites – report of the speciality sub groups (2008) – Department of Health
- ‘Shifting Care Closer to Home’ (2007) – Department of Health
- ‘Shifting Care Closer to Home Review’ – Department of Health
More recently, in 2012 came the ‘Care Closer to Home – Narrative Report’ (2012) – Royal College of Physicians and also the respected King’s Fund thinktank report, ‘Transforming the Delivery of Health and Social Care: The Case for Fundamental Change’ concluded that:
‘In the system of the future, the vision should be of ‘home as the hub’ of care, enabling patients and service users to take greater responsibility for their health and wellbeing, with the support of carers and families. Innovative providers are already demonstrating the scope for providing services in people’s homes that may previously have been available only in hospitals.
‘This includes, for example, the provision of intravenous antibiotics, chemotherapy for cancer patients and home haemodialysis for renal patients. Home care may also include the delivery of medication for patients with conditions such as rheumatoid arthritis and multiple sclerosis, and continuing health care for patients (including children) with complex needs.’