Moving care closer to home

The UK Government White Paper, Our Health, Our Care, Our Say sets out a vision to provide people with high quality health services in the communities where they live. This vision has been reaffirmed by the expectation of a National Health Service that is fair, personalised, effective, and safe, expressed in the Government interim report of the NHS Next Stage Review, Our NHS, Our Future.

Implementing this policy is, therefore, at the forefront of commissioning decisions. Practice Based Commissioning has the opportunity to play a key role in these decisions and allow GPs to shape these exciting changes and deliver high quality care closer to home.

The NHS Institute’s Care Outside Hospital programme was established to explore the scope for bringing about shifts in care within the NHS. The programme has found that, if everyone were to perform as well as the top quartile do now, some 50 million attendances in hospital outpatients, emergency admissions and rehabilitation stays for major conditions could be shifted from the traditional hospital setting and into the community.

The cost of delivering this activity is in excess of £2 billion and this funding could therefore be released to provide high quality services closer to home.

Framework

The NHS Operating Framework for 2008/09 expects PCTs to plan and develop changes to allow care provision as close to patient's homes as possible. PCTs are expected to take ambitious steps toward making this happen. This fits closely with the new competencies that have been developed to support the World Class Commissioning agenda. Central to these competencies is the capability to identify which services should be redesigned to bring them closer to the community and then deliver the resulting population-scale service improvements.

Shifting care from acute hospitals to community settings requires a great deal of coordination from all key stakeholder groups. To help achieve these ambitious targets, the NHS Institute recently launched a suite of products to support each step from initial planning and prioritisation to successful overall project delivery. The products include a series of approaches, which help commissioners shift care into the community and closer to patients’ homes.

These tools will give the greatest benefit for strategic health authorities, primary care trusts, practice-based commissioning groups and social and voluntary organisations in the process of commissioning or aligning with plans to deliver care closer to home.

The Care Outside Hospital approach — products in focus

Each local health community will have no shortage of ideas of how to bring care closer to home. These will invariably spring from the desire to deliver the vision for patients. The reality is that any health community will find it impractical to implement all of these ideas at once. A method of prioritisation is essential in order to focus resources initially on the most important and most achievable changes required.

The practical delivery of these projects and of the overall change programme also needs to be underpinned by a formal approach and methodology. The NHS Institute has worked with a number of health communities to develop tools to address this need.

The products are designed to help staff objectively analyse the most significant opportunities for their health community and determine priorities. Furthermore, they enhance the service improvement capabilities of organisations.

The focus of the products is split into three main areas: prioritising opportunities, overall programme delivery and individual project delivery.

1. Prioritisation of opportunities

In developing a Local Plan that sets out the local commissioning intentions within the context of the Operating Framework, PCTs need to decide which projects to take forward into delivery. These identified projects need to be documented in a proposal to be put forward to the local PCT board and, when approved, fed directly into the Local Plan. This is a strategic planning activity and is supported by the Prioritise Opportunities process, and the Opportunity Locator and Priority Selector tools.

The Opportunity Locator is an online tool based on local data that shows for each PCT the amount of care being delivered in an acute setting that could be delivered in a community setting. The Priority Selector online tool allows trusts to select the priorities on which to focus their change efforts.

2. Overall programme delivery

At the end of this strategic planning process, with the outputs approved and incorporated into the PCT’s Local Plan, the delivery of the programme can begin, using proven approaches and techniques that will help with overall programme management and individual project delivery. This resource takes the form of a series of short guides which help trusts understand issues from a whole-programme perspective, for example HR issues, finance issues, etc. Further guidance and resources are available in the What to Look Out for series which is due to be launched in early 2008.

3. Individual project delivery

Within the overall change program, the selected projects will need to be taken forward in order to deliver the desired changes in services. The approach, called Steps to Success, provides a simple yet robust model for undertaking these change projects more effectively and more quickly.

It is designed to take trusts through each stage of a successful project:

• get ready;
• start;
• set up;
• plan;
• do; and
• keep going.

Developed through a range of service-change projects of all sizes in a number of PCTs and health communities, Steps to Success is based upon a ‘gated process’ to ensure projects are focused and are managed to deliver the intended benefits.

Tested with over a dozen projects across the country, Steps to Success is proven to help PCTs deliver significant service improvement in an accelerated timescale. It fits closely with another product developed by the NHS Institute, called Commissioning for Patient Pathways, as well as the Map of Medicine, to which all PCTs have access.

What are the benefits to you?

These products and tools can help you objectively analyse the most significant opportunities for your local health community, and assist in determining the priority focuses for the local area. They comprise of a systematic and step-by-step approach to deliver service change and improve the services capabilities of your organisation.

Further information

The products are available to download online from www.institute.nhs.uk/careoutsidehospital