Welcome to the Research Brief, where Spotlight, the New Statesman’s policy section, brings you the pick of recent publications from the government, think tank, charity and NGO world. To see more editions of the Research Brief click here.
What are we talking about this week? Building community health and care capacity: Reflections from other countries, a briefing report into social care capacity in England published by the Nuffield Trust.
Nuffield who? The Nuffield Trust is an independent health think tank, focused on research and policy analysis that aims to improve the quality of healthcare in the UK. It originates from the Nuffield Foundation, a charity set up by the philanthropist and car manufacturer William Morris in 1943. Not to be confused with Nuffield Health, which also stems from the Nuffield Foundation, but is an entirely different organisation – a private healthcare provider.
What’s the gist of the paper? There’s a social care crisis in England and hospital beds are being taken up by people who should be receiving care in the community instead. According to the report, between December 2021 and December 2022, the number of patients in hospital who no longer needed to be there increased by 27 per cent. While the NHS is responsible for roughly half of discharge delays, around 25 per cent are also due to insufficient social-care capacity.
While the UK fares, surprisingly, pretty well in terms of hospital stay length compared with other OECD countries, many of these countries (like Germany) have more hospital beds than us. Compared to countries with similarly low levels of beds, we don’t do so well. The average length of stay in the UK is 6.9 days, compared to 5 in the Netherlands, 5.6 in Sweden and 5.7 in Denmark.
Better community social-care services are crucial for freeing up hospital capacity, and the UK can learn from more idyllic countries (read: Scandinavia) with successful care models.
[See also: Britain’s care deficit]
What’s so great about these other health and care systems? According to the report, countries like the Netherlands, Sweden, Denmark and Norway have historically done some things better than us, including investing more money and resources into out-of-hospital care, adopting a long-term approach to capital spending, devolving responsibility to local areas, and making social care more accessible by using a needs-based approach. For instance, in Denmark, a DKr40bn (£4.6bn) investment into capital spending over ten years – which went towards creating new facilities, electronic systems and better integrated care – led to 15 per cent less expenditure on inpatient services, plus reduced waiting times and hospital stays. While this will be due to a number of factors, it’s also notable that Denmark, Sweden, Norway and the Netherlands all have higher life expectancies than the UK.
How can we be more Scandinavia? The report lays out five key areas for focus that would help to improve England’s social care system. These include: spending more on community health and care services, rather than focusing solely on hospitals and urgent care; long-term planning, such as on capital spending to improve facilities and electronic health systems, and shifting health workers into the community; reforming the social care model so that it’s based on need rather than ability to pay, and, of course, investing in the workforce; devolving more responsibility for social care to local authorities to give areas more autonomy and the ability to offer tailored support; and joining up the health and social care professions, such as through establishing multi-disciplinary teams in the community.
But the NHS is on fire – shouldn’t we be focusing on that? Not really, say experts. While addressing chronic staff shortages, huge waiting lists for elective care, and high waiting times in emergency and GP settings is no doubt a priority, greater investment into long-term planning, capital spending, system redesign and prevention services would ultimately help to reduce the burden on the NHS. The chief executives of three of England’s largest health think tanks – the King’s Fund, the Health Foundation and Nuffield Trust – have said that the “current addiction to short-termism and eye-catching initiatives” means that the NHS will likely fail to meet the health and social care challenges of the future, which includes our ageing population and the rise in chronic disease. They say it’s time to “move away from quick fixes”.
In a sentence? The government needs to stop simply fighting fires, and instead make more sustained, long-term investment into improving health and social care systems, which will ultimately benefit the NHS.
Read the full report from the Nuffield Trust here.
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