Following the 10 Year Health Plan for England, the NHS is focusing on care that can be shifted 'from hospital to community'. But what is to be 'shifted'? Which kinds of activity are currently being provided in hospital settings that need not be? And how - at least in broad terms - could this be changed? 

Our analysis examines these questions. It will be valuable to strategic commissioners, providers, people developing plans for neighbourhood health services, policy makers - and anyone seeking to bring about a less hospital-centric NHS. 

We identify and quantify the type of acute admissions that could potentially be avoided if patients were instead cared for in community settings. We do this using the idea of 'potentially mitigable hospital activity'. 

This is difficult to identify. Reliably spotting activity that could be 'mitigated' means engaging with evidence, clinical judgement and data. 

But doing so is vital. Previous efforts to shift care have, in part, unravelled because of a lack of detailed attention. Our work fills this gap. 

By its very definition, the volume of 'potentially mitigable' activity is large. And the evidence in some areas is frustratingly imprecise. But - even in broad terms - our results suggest that gains are possible. 

Results are standardised by age and gender to allow for comparisons across Integrated Care Boards (ICBs). The findings reveal huge differences in the population rates treated in hospital. 

We don't therefore suggest that all the activity we identify can be avoided: only a proportion of it can be. But this report is an important source of insights for anyone wishing to understand the current levels, trends and comparative age-sex standardised rates for this type of hospital activity. 

Our analysis provides an evidence-based place to start: a basis for local plans, where context, detail and nuance can be added in. 

It is a guide for planning. Helping people assess the scale of the opportunities and challenges they face as they tackle the care shift agenda and work to secure the benefits this offers for the patients under their care. 

Users will find our introductory video guide useful. Peter Spilsbury, Director of the Strategy Unit, discusses the importance of this approach, and our analytical team describe how to navigate and interpret the report

 

The full analysis can be found here: https://connect.strategyunitwm.nhs.uk/nhp/community_mitigators/