A new report from The King's Fund said bold action needed to redirect energy away from treating acute illness, towards supporting people to stay healthy and manage their conditions.
Beccy Baird, senior fellow at The King's Fund and co-author of the report, said: ‘The structure and focus of the NHS has failed to keep pace with changes in disease and ill-health. Hospitals in England are well-placed to support the most acutely unwell, but too often they are treating patients that could have had their condition better managed in the community. An increasing number of us are living with long term health conditions that require regular, ongoing support. Boosting out-of-hospital services can help avoid the need for hospital treatment, meaning better care for patients and better value for tax-payers.'
The report said the shift to primary and community care could be achieved through returning hospital spending to below 50% of the NHS budget over the medium term.
It adds NHS spending allocated to acute hospital services has risen over the past decade, from 49% in 2010 to 58% in 2021. Over the same period the proportion spent on primary care has declined from 28% to 18%.
The report urges ministers to urgently review existing hospital waiting-time targets, arguing that the Government's dominant focus on reducing waits for elective care will distract from the much bigger prize of shifting to a more community-focused system.
Additionally, the authors warn the Government's recent decision to cut ICB operating costs by a further 50% this year risks perpetuating the dominance of hospitals in how health and care services are planned and delivered and will make the shift from hospital to community even harder to deliver.
The report makes a number of recommendations, including: urgently reforming adult social care; empowering local GPs and ICBs with financial flexibility; and investment in community based infrastructure and technology.
Reaction
Ruth Rankine, primary care director at the NHS Confederation, said: ‘In the current difficult financial climate we recognise that the ambition to shift care into the community feels ever more challenging. We understand the need to stabilise public finances in the short-term, but this must be balanced with implementing the reforms that are vital to putting the NHS on a sustainable long-term footing.'
Interim chief executive of NHS Providers Saffron Cordery said: ‘Action is long overdue. The upcoming 10-Year Plan for Health presents a critical opportunity to finally deliver this longstanding national ambition.'
A Department of Health and Social Care spokesperson said: ‘Shifting care from hospital to community is a key priority for this Government – with us already boosting NHS primary and community care, hiring 1,000 more GPs, increasing GP funding by £889m and expanding Community Diagnostic Centres and surgical hubs so patients can get tests, checks scans and treatment faster and closer to home.
‘Along with an extra £26bn investment to get the health service back on its feet, we are bringing in fundamental reform that will mean more people treated in the communities they live in, as well as a vital shift from analogue to digital and sickness to prevention.
‘We have also reduced the number of targets for NHS leaders and are abolishing NHS England – the world's largest quango – to cut red tape and divert hundreds of millions to the front line.'
