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Imagine yer-granny falls over, at home on a Friday afternoon.
It’s no so difficult, it happens a lot.
She’s shaken, you're worried, and nobody is sure whether she can manage the weekend.
A nurse who can assess her, a GP who knows her and a care worker who can get her up the next morning might make the difference between staying home and going to hospital.
If those people can’t be reached, there’s one place her daughter knows will be open… A&E... reach for the phone.
That’s why the NHS keeps coming back to neighbourhood care. It’s a good answer to a problem that families encounter every day.
It’s also an old answer.
- England had Integrated Care Pilots in 2008,
- Pioneers in 2013
- Vanguards in 2015…
… the latest framework asks NHS boards and councils to draw up local neighbourhood plans for 2027/28.
After nearly two decades, it’s fair to ask what will make this attempt any different?
The Vanguards tell us something worth remembering...
... the national evaluation found that emergency admissions grew more slowly in the care-home settings...
... the effects in schemes covering the wider population were smaller and took longer to show up.
Across the programme, there was no significant reduction in hospital bed-days.
Helping a group of people get better care is an achievement in its own right. Turning that achievement into enough spare hospital capacity to move money around is a much bigger ask.
Here’s where the new plan runs into trouble.
The government expects local NHS boards to pay for neighbourhood services mainly by redirecting existing resources, but …
… the hospital can only release meaningful sums once enough demand has moved elsewhere…
... demand can only move elsewhere once the community service is staffed and ready to absorb it.
A district nurse might prevent three maybe more, admissions this week...
... the hospital still needs a ward, a night shift and a doctor on call. In a busy hospital, the beds will be filled by patients already waiting for them.
The community nurse has made life better for three people and given the hospital some breathing room.
The finance director still has the same wage bill.
The NHS has to pay for both services.
Then there’s the question of who does the work. The National Audit Office cited;
'... a 43% fall in staff recorded in NHS district nurse roles between 2009 and 2024.'
Other community roles grew, but the data couldn’t tell the auditors how much of that growth went into supporting people with frailty.
If yer granny falls and needs someone to help her wash and dress on Saturday morning, the NHS team depends on a local care service having someone available.
A meeting on Friday can establish exactly what she needs. It can’t put a care worker on Saturday’s rota and by the way..
... last week the National Audit Office reported that integrated care boards had been told to cut their running costs by 43% with planned staff reductions equivalent to about a third of their workforce.
Restructuring had already affected relationships with local partners...
... the very organisations being asked to sit down with councils, GP practices and hospitals and agree who will do the work, who will pay and what each can safely give up.
I expect some places will make this work. The positive deviants. They’ll have people who already know one another, services they can build on and enough room in their budgets to get started.
The test for a national policy is what happens in places where those things are scarce.
When the local plans finally emerge… I’d look for two things.
First, the money committed to staffing community-services before the hospital savings are booked.
Second, what services can meet the Friday afternoon test.
Yer granny and you will judge neighbourhood care by who turns up, how soon they get there and...
... whether someone comes back in the morning.
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