A new study finds a lack of evidence of cost savings and the necessary systematic decommissioning of hospital services when moving care into the community

Getting out of Hospital? a new report by the Health Foundation which summarises the best available evidence has found that moving care from hospitals into the community improves patient satisfaction. However, there is not enough compelling evidence on the potential savings that can be made from moving care into a community setting and little evidence of the necessary systematic decommissioning of hospital care.

Stephen Thornton, chief executive of the Health Foundation commented:

'Rethinking traditional patterns of where and how care is delivered will be fundamental in addressing the dual challenge of delivering better care that patients prefer whilst controlling costs. We need to bite the bullet and close wards and we need to prepare and scale up get out of hospital care which is hugely fragmented.'

The report confirms community-based services can, under the right conditions, provide quality of care as good as that in hospital and, in some instances, at lower cost. The research also found that successfully implemented projects that moved care into the community tended to be part of a more strategic plan to deliver service improvement.

The report points to the promotion of early discharge for patients that do not need intensive acute help but who are not ready to look after themselves as having the most potential to save the NHS money through moving care. However, for significant cost savings to be realised inpatient services need to be reduced or decommissioned once the new service has been set up. Unfortunately there is little evidence of this systematically happening in practice.

Stephen Thornton continued, 'Community services are going through a period of significant change – indeed, we have a natural experiment with the development of community foundation trusts and community services going into foundation trusts and mental health trusts – which gives an opportunity to try new ways of working. Genuinely clinically led commissioning would also stand a better chance at making the changes – though only if the hard decisions can be made.'

The Health Foundation believes that to help decision-makers scrutinise all the options available to them for delivering cost effective care requires further work to focus on the costs incurred and savings made when shifting care into the community.

Stephen Thornton concluded, 'We hope this report provides commissioners with high-quality evidence to underpin the decisions they need to make with the best available evidence pulled together around key conditions and services.'

Notes to editors

Getting out of hospital? reviews the evidence concerning the relative efficacy and cost-effectiveness of community-based treatment regimes. In particular, it focuses on the evidence for shifting acute inpatient and day case services from hospital into the community. It is a rapid evidence assessment which updates earlier systematic reviews.

The research team from Matrix Evidence carried out a rapid evidence to explore international evidence on the benefits and potential harms of shifting acute inpatient and day case services from hospital into the community. Supported by the Information Retrieval Unit at King’s College London, the team searched the following sources:

• Medline
• Embase
• HMIC (a recognised source of ‘grey’ literature)
• SPP
• ASSIA
• Web of Knowledge.

The search revealed 26 studies reporting primary research or systematic reviews of primary research. The review team assessed each study for methodological quality using a standardised evaluation tool and concluded that the overall quality of the studies was high. The team also conducted supplementary searches for additional reports and opinion pieces on the topic.