Government outlines NHS Plans to Keep Vulnerable out of Hospital

Under plans announced by the Government today, out of hospital community services including falls and frailty teams will be scaled up, with up to 50,000 people a month supported by clinicians at home in high-tech ‘virtual wards’.

Urgent community response teams will be scaled up to provide more patients with support at home within two hours, in recognition of the pressures facing A&E.

The Government and NHS England will publish an Urgent and Emergency Care Plan this week to reduce waiting times and improve care for patients.

Tailored support

Tens of thousands of elderly and vulnerable people will receive tailored support at home each month as part of a new NHS plan to curb unnecessary trips to hospital, help at-risk patients receive faster treatment and improve ambulance response times.

Since the pandemic, demand on the NHS has risen, driven by several factors including an ageing population with increasingly complex needs. The Government intends to reform the way the NHS provides services to adapt to the population’s changing needs, including by expanding care outside of hospitals

Building on learnings from this winter, the Government hopes that by standardising and scaling up falls and frailty teams of nurses more people will be kept out of hospital. Ahead of next winter, the Government hopes it will ensure more services are in place.

With local areas developing plans to streamline these teams, they are intended to join up care by connecting hospital expertise with emergency services and use technology to reduce the risk of falls by remotely monitoring patients.

Increasing numbers of falls

With an ageing population, falls are becoming increasingly common, and some people are less able to cope and recover from accidents, physical illness or other stressful events which can lead to serious injuries, hospital admission, and subsequent moves into long term care. These services are designed to support vulnerable patients at home and in the community to remain living independently for longer, with up to 20% of emergency hospital admissions avoidable with the right care in place.

The NHS has already rolled out virtual wards – treating patients from the comfort of their own homes – with growing evidence that these are a safe and efficient alterative to hospital care, particularly for frail patients. These see patients supported by clinicians to recover in the comfort of their own home, rather than in hospital – and has increased the number of patients that can be cared for in this way by 7,000, a 50% increase since last summer. Another 3,000 ‘hospital at home’ beds will be created before next winter and the plan will include an ambition to see up to 50,000 people supported a month.

High tech virtual wards currently support frail elderly patients or those with acute respiratory infections and cardiac conditions. Patients are reviewed daily by the clinical team who may visit them at home or use video technology to monitor and check how they are recovering.

Commenting on plans announced today, Health and Social Care Secretary, Steve Barclay said:

“The health and care service is facing significant pressures and while there is no quick fix, we can take immediate action to reduce long waits for urgent and emergency care.

“Up to 20% of hospital admissions are avoidable with the right care in place. By expanding the care provided in the community, the most vulnerable, frail and elderly patients can be better supported to continue living independently or recover at home.

“This includes rolling out more services to help with falls and frailty as well as supporting up to 50,000 patients a month to recover in the comfort of their own homes. Not only will patients benefit from better experiences and outcomes, it will ease pressure on our busy emergency departments.”

NHS England Chief Executive, Amanda Pritchard said:

“The NHS has faced unprecedented pressure this winter – with the “twindemic” of flu and Covid becoming a reality, alongside surging demand for all services, from GP appointments to A&E attendances and ambulance call outs.

“Our extensive planning ahead of winter has helped to boost capacity – from extra 111 and 999 call handlers, to new falls services and more beds – and we now aim to build on that progress to help speed up care and improve the experiences of patients.

“Boosting care in the community and treating more people at home is key to recovery – it is better for patients and their families, as well as easing pressure on NHS services.”

out of hospital care and rehabilitation services were under pressure during the pandemic
Rehabilitation services were badly impacted by the pandemic

Over 80% of patients referred seen within two hours

Urgent community response teams will also be scaled up to increase the number of referrals and patients seen by a range of health and social care professionals within two hours, with services running 12 hours a day. According to the latest data, across the country, over 80% of patients referred were seen within two hours.

These teams work with 111 and 999 services to provide urgent care to people in their homes, avoiding the need for hospital admissions and enabling people to live independently for longer, backed by a planned £77 million investment to support systems to continue to improve community health services in 2023-24.

Falls and frailty services have already been shown to improve patients’ experiences and reduce pressure on urgent and emergency departments. For example, South Warwickshire University NHS Foundation Trust has rolled out an integrated frailty service linking up emergency services and hospitals.

As part of this, ambulance crews who are with the patient at their home can arrange a remote consultation with input from a consultant to agree the best course of action – from monitoring on a virtual ward to a face-to-face assessment. Thanks to this approach, there has been a 16% reduction in the number of patients aged over 75 being taken to hospital in an ambulance, enabling frail older adults to recover at home where that is best for them.

Taken together, the Government hopes these measures will help improve experiences for patients across the country and make it easier to access the right health or social care, all while reducing pressure on hospitals and preparing the NHS for future challenges. This will be backed by up to £14.1 billion available for health and care services over the next two years – the highest spend in any government’s history – which was announced in the Autumn Statement.

Chairman of the Local Government Association, Cllr James Jamieson said:

“We are pleased to see the focus on expanding community health and care services and the recognition of the importance of therapy and recovery support to get people back home following discharge.

“Collaboration and a focus on outcomes will be key to successful delivery of the plan.”

The President of ADASS, Sarah McClinton said:

“We recognise the importance of expanding and joining up health and care in people’s homes to stop them needing to go into hospital and enabling people to leave hospital safely with therapies and support to recover. Key to achieving this will be co-producing plans across health and social care and investment in the workforce in social care and community services and we look forward to engaging with this.”

Final thought

Ben HEad

Ben Howlett

Chief Executive, Curia

Asks if the Government realises just how long-term the plan they announced today is?
Curia is a policy institute that looks specifically at turning policy into practice.

Helping to stop the flow of frail patients into hospital is a good thing.

There is no doubting that this Government is spending more on healthcare than at any other time in history. However, putting aside the traditional criticism of why is more money going in with poorer outcomes, the big question is why an approach to demand in falls is being levelled at a system that has a problem with supply of adequate social care accommodation.

It is fine to provide more ambulances, but if you cannot get the patients out the hospital door into social care, then you are merely paying enormous amounts of money for trollies sitting in ambulances outside.

More support for the community to prevent patients entering hospital is a good thing, as a large proportion will come from social care anyway. However, there is still a large number as a result of care at home. How will thousands of patients benefit from ‘virtual wards’ when they can’t even access the internet?

These are good headlines for a government wanting to show the public that they have a long-term plan. However, when you dive a little deeper, not much stacks up about their approach.

Buy 5,000 new beds for the NHS – where are they going to be put in an estate that is literally bulging in capacity? With strikes about lack of safe staffing and training taking years, how will the NHS staff these beds?

This was a problem that started over a decade ago, I wish the Government well in trying, but I would doubt they will feel the results of their interventions until the end of this decade – long after a General Election.

To find out more about Curia’s NHS Innovation and Life Sciences Commission and Levelling Up Commission focused on prevention and improved integration between health and social care visit


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