The Government recently announced its plan to address the UK’s struggling urgent and emergency care systems, by promising thousands more new ambulances and hospital beds.
While we welcome these new measures, it’s clear that current intolerable pressures on our A&E services will not be solved by this sticking plaster alone.
The causes of our current healthcare crisis are complex and run deep, stemming from long-term failure to address the twin pressures of an ageing population and the rapidly growing number of people with multiple complex medical conditions.
The Government therefore should also think seriously and radically about supporting a new set of highly tailored services that are putting patients first; getting to the heart of the causes – and not just the symptoms – of this crisis.
Take Healthier Devon, a diabetes prevention service operating in the 40% most deprived areas of Devon. Or the Reactive Emergency Assessment Community Team (REACT) – a palliative care service developed in Bradford which supports patients admitted to A+E in avoiding staying on in hospital through identifying their palliative care needs at home.
Both are taking on two areas of serious concern for the government. Recent data shows that the NHS spends around £10bn a year - 10% of its entire budget - on diabetes. While REACT is tackling one of the Government’s biggest healthcare headaches; no political party has yet formed a solution for the fact that in the next 25 years, health services will need to adapt to the doubled population of those aged 85 and above.[1]
Healthier Devon and REACT are both funded through an alternative form of public service commissioning known as social outcomes partnerships - which brings together alternative funding streams such as private investment to bolster stretched government funding.
This model has several benefits. Firstly, it means the critical services can be delivered by a network of local charities and social enterprises on the ground – who very often who have a deep understanding at the issues at hand and can offer personalised, flexible care. Another is that the outcomes of these programmes are assessed regularly and transparently, meaning is easy to measure their effectiveness and adapt when needed – and which is unfortunately not the approach of more traditional public service delivery programmes.
This leads to better results for patients when compared to centrally run services. For example, 33% more patients referred to Healthier Devon start the programme than those referred to their centrally run counterparts. While in 2022, REACT enabled 65% of patients in need of palliative care to be discharged into their community without needing to be admitted into hospital. This compares to a national average of 45.6% of those aged 65 and over dying in hospital.[2]
The good news is that they do not cost the government more. In fact, reducing strain on emergency services in this way saves the taxpayer and the NHS money in the long run. For example, dying at home rather than in hospital saves the NHS £3,500 per patient.[3] And independent analysis published last year shows such projects to date in the UK have created £1.4bn of public value at a cost of just £140m to the commissioners. That means for every £1 that the government has spent, a further £10 of public value has been created.
The UK is a global leader in social outcomes partnerships, but we’re at risk of losing this position. Commissioners are facing challenges such as tight budgets, limited time and structural barriers such as uncertainties around annual spending – all of which limit their capacity to innovate through commissioning contracts like these.
What’s more, people with complex healthcare needs often fall through the gaps of care offered through existing public services. Very often, their needs do not appear to fit clearly into any department (or local government’s) spending areas; thereby limiting capacity for local commissioners to commit to budget or time on new models for long-term care.
This could be devastating for the future of the nation’s health. More hospital beds are certainly very welcome – but if the Chancellor truly wants to address longer-term and complex causes of the strain on our healthcare system, he should also seriously consider the potential and future of outcomes partnerships.
To learn more about the potential of social outcomes partnerships in helping to solve the UK’s health crisis, read our recently launched report.
[1] Our ageing population - The Health Foundation
[3] https://www.nuffieldtrust.org.uk/files/2017-01/end-of-life-care-web-final.pdf
