Shifting the balance of care: Great expectations
This report forms part of our (The Nuffield Trust) work programme on new models of care, and also contributes to our ongoing work on Sustainability and Transformation Plans (STPs). We have a long track record in analysing the evidence base surrounding out-of-hospital care and, with the need to move care from hospital into the community a core part of STP plans across the country, a review of the evidence is both timely and necessary.
This research draws on an extensive literature review to assess the realism of the narrative that moving care out of hospital will save money. It sets the context of this through analysis of hospital activity data over ten years. The literature review focuses on initiatives that were expected to impact on hospital care, as this is what STPs predominantly focus on. We explore these by looking at five key areas: elective care, urgent and emergency care, admission avoidance and easier discharge, at risk populations, and self-care.
This report aims to inform the development of STPs to ensure that they are drawing on the best available evidence. It also seeks to dispel some widely held myths about the ‘magic bullet’ of shifting care into the community.