The National Health Service and the public's 'default setting' for delivering healthcare must be shifted from hospitals into the community/home setting, as part of a system-wide change in approach to help weather the growing pressures it faces, a report by the NHS Confederation has concluded.

Inpatient care should be reserved in major hospitals for patients with life-threatening illnesses or those needing complex surgery, which could boost clinical efficacy and help the Service make more of its available resources, according to the report, Transforming local care.

This, it states, should be underpinned by a system-wide change in which commissioners and service providers work together for the benefit of local health economies in order to put the NHS in better stead for meeting the significant demands it faces.

The Confederation has long argued that health services provided in the community have a crucial role to play in meeting this challenge, because, it claims, providing care closer to the homes improves health as well as the experience of care, and so helps reduce avoidable hospital admissions and readmissions through prevention and early intervention.

As such, it has now called on both the government and the NHS Commissioning Board "to facilitate the necessary change by ensuring health and social care funding supports the transfer of care into community settings". 

The quality and sustainability of health and social care services could be transformed with the development of payment systems rewarding prevention, early intervention and integrated working, coupled with the reinvestment of efficiency savings into community-based service delivery, it argues.

Acute hospitals - whether major teaching sites or local district generals - are rarely the best place for someone who needs ongoing health or treatment," said Jo Webber, interim director of policy at the NHS Confederation. "It is time we started thinking differently right across the country, and making sure investment supports innovative service delivery that supports patients' independence and recovery."

Webber points out that there are already "groundbreaking services" in place in some parts of the country transforming patient experience and care quality, which are helping to make the NHS more efficient overall. 

And with regard to the potential of community care, the report cites several examples of where this has improved outcomes. One telehealth scheme in Liverpool, for example, saw a 73% reduction in emergency hospital admissions for acute coronary syndrome, it notes.

Mixed views

A separate report, published last month, also found that a hub pilot in Yorkshire showed telehealth can reduce hospital admissions, provide care at home and improve patient outcomes.

The British Medical Association, however, recently questioned the UK Government’s telehealth plan, saying it will add significant workload for GPs and will not likely help patients.

In November, health secretary Jeremy Hunt announced that plans to roll out the government’s 3millionlives programme - which is looking to get telehealth schemes out to three million extra people in the UK by 2017 - is “well under way”. 

But the BMA’s GP committee says that whilst it shares the UK Government’s wish to cut patient waiting times and increase efficiency of care, it does not feel that telehealth and remote monitoring schemes are necessarily the right way of doing this.