Academy of Medical Royal Colleges Report AoMRC ‘The Future is Out There: Joining up health and care for the benefit of all’

The government, through Lord Darzi, has set out three big shifts which will rebuild the NHS; one of these is the shift from hospital to community. The idea underlying this is shift is that preventing ill health is better for patients and allows scarce hospital capacity to be utilised for those in acute emergencies. The case for this shift has been made repeatedly over the past two decades; the question is not why shift, but how do we do it.

The response to the ‘how’ question is set out in The Future is Out There – stop talking and get on with it which we have supported the Academy of Medical Royal Colleges to publish. This paper sets out four actions to be delivered in partnership between central governments (the UK government and the devolved administrations) and local health and care systems. These actions were identified through a roundtable convened by the Academy and IMPOWER which brought to together clinical leaders, think tanks, patient representatives, and policy designers. The proposed actions are supported by case studies from our work to show that delivering this is possible.

The four proposed actions to deliver the shift to community are:

1. Shifting the priorities, culture and delivery towards home-based care:
2. Reshaping care from a traditional medical model to a tech-enabled social model by:
3. Growing the scale and quality of home and community-based care by:
4. Changing where the money goes and what we measure for success by:

All of these actions are already underway to varying degrees across health and care systems; and more evidence of the positive impact of the shift to communities is becoming available. There is growing evidence, for example, that when done well Hospital at Home services improve outcomes for patients when compared to more traditional inpatient models of care and reduce the rates of readmissions to hospital. The progress which we are making is testament to the vision and determination of local leadership.

Darzi recognises, however, that within the current structures of the NHS better managerial decisions will only create marginal improvements. To achieve success at scale we need a new compact between the centre and localities, so that the shift is enabled and regulated by funding flows and performance regimes.

So, shifting the emphasis of health and care to communities is possible. It can be done; and this report shows how. At IMPOWER we have been fortunate to work with some of the leaders who have contributed to this paper and who are showing the way. If local ambition can be met, and enabled, by the centre then the future is, indeed, out there.