Sharing the learning on out-of-hospital care

by Ros Preen

08 March 2018

Out-of-hospital care has a huge role to play in developing new models of care that better meet the needs of patients in a sustainable way. A new HFMA special interest group will provide a forum to accelerate understanding; developing the thinking and approaches to addressing this agenda, and demonstrating and delivering best value for health systems.

Effective out-of-hospital care is essential to keep the population healthy and independent, and key to meeting the aims of sustainability and transformation partnerships (STPs) across the country. However, community services face major challenges, with financial and workforce issues taking centre stage.

The diversity of activities and the interplay with other local services mean that no two providers are exactly the same, yet there are many similarities. This means that opportunities to learn from each other are valuable. The HFMA is offering members just that opportunity through the creation of the new Out-of-Hospital Care Special Interest Group.

Good out-of-hospital care can play a key role in reducing people’s need for urgent and emergency care. The prevention of crises through effective management of conditions, supported by NHS community services and others, can have a real impact on the demands placed upon the acute sector. However, understanding and quantifying this relationship between acute and community services can be challenging.

It is essential that the case is made for investment in out-of-hospital care. Commissioners and providers need to develop a broader understanding of both the value that it can bring and the complexities of commissioning the services that their population needs.

The reporting of NHS financial challenges often focuses on the acute sector, but the challenges are present across all parts of the system. Financial pressures in community health services are less easy to quantify as most contracts are on a block basis and changes in activity are hidden. NHS community providers are significantly impacted by the funding challenges elsewhere in the public sector, with district nurses and other community staff undertaking tasks traditionally in the remit of social care.

An early focus for the new HFMA group will be to consider the value that out-of-hospital care delivers for the local health and care economy. There is a presumption that moving more services outside hospitals will reduce overall system costs. Even where this is not the case, it may well deliver better value, measured in terms of outcomes, patient experience and costs. But the NHS needs a better understanding of the implications of some of the changes being explored.

The group will aim to pull together examples from across the country of where community providers are having an impact on hospital admissions and enable this learning to be shared across the HFMA community.

Innovative approaches to delivering out-of-hospital care can be found across the country. In some cases, this means a different setting for an intervention traditionally delivered in hospital; in others it can mean a new, integrated, approach across several sectors to support people to manage their conditions.

While local circumstances mean that programmes may not be directly replicable, elements of them can often be applied elsewhere. The structures that support these different approaches are sometimes overlooked in the published case studies for new service delivery. The new group will allow a focus on the parts of the system that enable the approaches to be successful.

Alongside all this change, it is essential that services continue to get the basics right – delivering the day-to-day support that many people rely on. The challenge here is to do so within the financial constraints affecting the whole system and ensure that they are being delivered in a sustainable manner. Here the workforce challenge comes to the fore for community services providers, which often have an older workforce and can struggle to recruit in more rural areas. Finding ways to continue to deliver effective services while staff numbers in some areas are decreasing, for example district nursing, requires organisations to revisit established service models.

Reducing service fragmentation, building better links and understanding with colleagues in primary care and mental health, can help to avoid duplication of effort and ensure a seamless transition between organisations. Recognising that many members will come from combined trusts, the group will not be working in isolation. When it makes sense to do so, work will be combined with other HFMA groups such as the Mental Health Finance Faculty, where work will shortly be underway to consider the impact of the Carter review.

Of course, there are also areas where we can learn from colleagues working in the acute sector, who typically have had earlier access to efficiency tools.

The establishment of the Out-of-Hospital Care Special Interest Group offers a fantastic opportunity for those working in community services to have a forum to discuss challenges and opportunities, while contributing to wider work of benefit to the whole sector.

Interested in getting involved with this group? Contact

Out-of-hospital care will be a hotly discussed topic at the upcoming Convergence conference - find out more now