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Long term plan: how it aims to keep people out of hospital


By Beth Gault
9 January 2019

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The NHS long term plan has pledged to save half a million more lives through key changes to the delivery of the health service and what it offers.

Published on Monday, the plan hopes to reduce preventable illness and to, as much as possible, prevent the public from needing to access emergency services, which are stretched across the country.

This includes placing greater emphasis on primary and community care in order to shift workload away from hospitals.

The plan suggests that in the three years of ‘testing alternative models’ since the Five Year Forward View, vanguards and ICSs have had a ‘positive impact’ on emergency admissions, despite receiving less than one tenth of one percent of NHS funding.

Therefore, the plan has committed to extending these systems in a ‘series of community service redesigns’.

But what exactly do these redesigns entail and how does NHS hope to use them to reduce hospital admissions and decrease the demand on emergency care services?

How does the plan hope to increase prevention? 

The plan aims to deliver more tailored NHS services within the community, with the objective of preventing avoidable hospital admissions.

In boosting primary and community care, the NHS will expand community multidisciplinary teams to give care to those who need it before hospital admission becomes a necessity.

The teams will include GPs, pharmacists, district nurses, community geriatricians, dementia workers and allied health professionals such as physiotherapists, alongside social care and the voluntary sector.

Within the next five years, the plan outlines, an extra 2.5m people will also benefit from social prescribing, a personal health budget and new support in patient groups and from the voluntary sector – all measures designed to give patients the ability to better manage their health.

By 2020/21 primary care networks will assess the local population by risk of ‘unwarranted health outcomes’ to try and enable earlier detection. The networks will then make care available to those who need it, working with local community services, to extend help when people most need it.

Technology will also be used to prevent incidents that might otherwise have ended in hospital admission, including using digital scales to monitor a patient’s post-surgery weight, and issuing location trackers for those with dementia.

What about reducing hospital admissions once urgent care is needed?

The key phrase here is integration of services.

The NHS has laid out plans to support patients in knowing which service is best for them to use via the clinical assessment service embedded within NHS 111, ambulance dispatch and GP out of hours services.

This service will be available from 2019/20, and will aim to navigate patients to the ‘optimal service channel’.

It will provide advice, treatment and referrals via various healthcare professionals, covering both physical and mental health, and will have access to medical records to ensure good care is delivered.

The objective behind this initiative is better navigation of the NHS to ensure patients see the appropriate health professional and avoid hospital stays.

Other urgent services available to patients will include urgent treatment centres, which will be fully implemented across the country by 2020 and acute frailty services – to be established to allow multidisciplinary teams to assess and treat patients who might otherwise have to be admitted to hospital.

What about funding?

Boosting primary and community services will come at a cost and the plan promises to grow investment in primary medical and community services faster than the overall NHS budget over the next five years. This will see a funding boost of £4.5bn a year by 2023/24.

Primary care networks will also be offered a shared savings scheme, through which they can benefit from reducing avoidable A&E attendances, admissions and delayed discharge.

How will the success be measured?

In the next five years, all parts of the country will be expected to improve the ability of their community health crisis response services to deliver care within two hours of referral, in line with NICE guidelines.

 

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