A new report shows that the UK is behind other comparable countries when it comes to the speed of discharge from hospital for medically-fit patients. This is due to under-investment in health care and a lack of coordination across the system.
The NHS has been working to move patients from hospitals to the community in order to create much needed bed space. Prime Minister Rishi Sunak pledged to reduce waiting lists for routine health care before the election next year.
The Nuffield Trust stated on Tuesday that while some countries, such as the Netherlands or Denmark, have been able to shift more care into community settings with success; “progress has been minimal in England” and the delivery of these goals.
The report of the think tank, which used both international data sets for the UK as well as detailed analyses of England’s Health Service, stated that “insufficient capacity” in community health care services had “beleaguered system for many years”.
Researchers found that while the average hospital stay of UK patients compared favorably with those of other OECD countries, the UK appeared to be underperforming when compared to other health systems which had a similar low number of acute bed.
They noted that the NHS was slower to send patients home than other countries, such as Sweden, Denmark, and The Netherlands, all of which have similar bed bases.
England has seen a significant increase in waiting lists for treatment that is not urgent due to difficulties in releasing patients who are deemed fit. Sunak’s declaration in January that it was a “people priority” and invited voters to judge his performance on the backlog by the next time they go to vote, gave the 7.6mn record a new political urgency.
Nigel Edwards is the Nuffield Trust’s chief executive. He said that the study revealed the NHS focuses too much attention and investment on measures to prevent hospital admissions but not enough on the “backdoor”. . . Sorting out patients who should not be in the hospital, and could be better cared for, more effectively and safer in other places”.
NHS England data shows that between December 2022 and December 2023, the number of hospital patients who were able to leave the hospital but did not have the courage to do so increased by 27%. The study found that 70 percent of those who had been admitted for more than three weeks were waiting on community health and social services such as home care or rehabilitation.
The proportion of NHS budget allocated to primary care and community services has fallen in the last three years.
Researchers found that the Netherlands, Sweden Denmark and Norway, respectively, allocate 62 percent, 60 percent, 58 percent and 55 cents of their total health expenditure per person to outpatient, preventive and long-term care, compared with 52 cents in the UK.
In many countries, the local municipality is responsible for providing community health care and social services. However, in England, accountability is usually split between local councils, and the NHS.
Edwards referred to a “vicious circle” where patients are discharged without receiving the support they need to continue their recovery. This increases their likelihood of being readmitted.
He did acknowledge that a community-centric strategy was not a panacea. Several countries have found that structural changes may not be as effective without adequate funding. Denmark’s 2007 restructuring saw hospitals consolidated into larger regionalised units while smaller hospitals became intermediate care facilities or “step down” facilities.
The report stated that the proportion of Danish health expenditures invested in inpatient care fell by 15% over the last decade as the majority of the care was moved to outpatient settings.
Karsten Vrangbaek of the Centre for Health Economics and Policy of the University of Copenhagen said that Danish politicians used “a kind of strong rhetoric” to claim that centralising hospitals will allow for more specialised services. “It was sold as a way to improve quality.”
He noted, however, that granting municipal governments greater powers revealed differences in funding and staffing levels each could command. However, he said, tighter state regulation and a redistribution system from richer to less wealthy municipalities had reduced this level of variation.
Nuffield stated that in the Netherlands “evaluations on long-term care reforms concluded smaller municipalities lacked sufficient capacity to fulfill their new responsibilities”.
Madelon Croneman is a senior researcher with the Netherlands Institute for Health Services Research. He suggested that the Dutch government overestimated savings from decentralising healthcare in order to curb “unsustainable growth” of healthcare expenditure.
She warned that as costs continue to rise, Ministers have tried to limit the number of people leaving hospitals for expensive long-term homes. However, this has meant families are increasingly expected to provide the support needed by their loved ones.
Kroneman noted that the new approach has also increased pressure on GPs. He said that there is a consensus in the industry that “the right care at the right place” should be the focus. . . “But it’s not clear what the ‘right’ place is”.
The Department of Health and Social Care stated that it “worked to ensure that patients leave the hospital as soon they are medically able” and “the number of each day patients who are ready for discharge has decreased by approximately 2,800 patients in England since January”.
The statement said, “We will invest a record £1.6bn in support of this initiative on top of the £700mn we invested last winter to relieve hospital pressures and purchase thousands of additional care packages and beds.”
NHS England has “rapidly increased the use of outpatient care” and is “increasing patients treated in their homes or communities”.
The article added that “virtual hospital beds” can help patients avoid unnecessary hospitalizations by treating them at home. . . “[and] recover quicker where they feel most comfortable”.