Government ‘must rethink NHS waiting times targets to move care closer to home’

The Government must rethink NHS waiting times targets and the amount it spends on hospitals if it wants to move care closer to home, according to a new report.

The King’s Fund charity said strong political leadership was vital if the Government’s desire to care for people outside of hospitals is to become a reality.

Its new report said: “It is abundantly clear that strong political leadership that prioritises this shift, and remains focused on it, will be critical.

“If this is pushed to the ‘nice to do once we’ve sorted waiting times’ column, then it will remain an unimplemented policy for another 30 years.”

The Government has set out its desire to move more care out of hospitals and into the community – an ambition laid down by successive governments.

The King’s Fund said ministers must not repeat previous mistakes and instead use levers to ensure the shift happens this time.

According to the King’s Fund, one in four people in England live with one or more long-term conditions, many of which will never be cured and instead will require constant management and support.

It said the NHS needs to focus far more on the services in the community, such as GPs, district nurses, pharmacies and occupational therapists, that support people to stay well and independent and away from hospital beds.

In its study, the charity calls for more power to be given to local leaders as “the prevailing culture in the health and care system has led to a constant looking upwards for guidance, rather than downwards and outwards to patients and communities.”

The report also notes that the proportion of NHS finances spent on primary care such as GPs and community services has decreased over the past decade compared with acute hospital services.

In the decade before 2010, the proportion of the total budget spent on acute services hovered around 49% but by 2021 it had risen to 58%, it said.

Over the same period, the proportion spent on primary care services decreased from around 28% to 18%.

The report recommends the Government “set a funding or financial target that demonstrates its commitment to making care closer to home a reality – for example, increasing the overall proportion of spend on primary and community care services, as opposed to emergency and acute hospital services, through a commitment that hospital expenditure will return to accounting for less than 50% of frontline NHS expenditure within a defined period”.

On waiting times, the King’s Fund said the “prevailing view of national policy has been that care closer to home is the long-term goal but only after hospital waiting times are fixed, whether that’s elective care waits or A&E waits”.

However, it argued that waiting times targets are very unlikely to be met without the “enormous injections of resource and focus that were seen in the early 2000s”.

Instead, the report said the Department of Health “should urgently reassess current elective waiting-time targets and whether they can realistically be delivered at current timescales without significant opportunity costs for its plans to make care closer to home a reality”.

Another issue holding back care closer to home is the lack of a long-term plan for adult social care, the King’s Fund said.

It called on the Government to bring forward the timescale for the new commission looking at social care, and to examine, for example, whether home care workers are supported to take on more health-related tasks.

Beccy Baird, senior fellow at the King’s Fund and co-author of the report, said: “English hospitals 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 taxpayers.

“For ministers to succeed where their predecessors have failed, they will need to take bold action.

“History tells us that warm words and soft ambitions won’t cut it – delivering this change will require hard targets, including the mandated rebalancing of funding towards primary and community services.”

A spokesperson for the Department of Health and Social Care 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 £889 million 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 £26 billion 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.”

Professor Kamila Hawthorne, chairwoman of the Royal College of GPs, welcomed the report but called for more primary care funding, adding: “Last month we delivered over 30 million appointments – over a million a day, all with a steadily shrinking portion of the NHS budget.

“But we can’t go on like this. Our GPs and their teams are exhausted, too many patients are still waiting too long for care, and we certainly can’t deliver a revolution of care close to home when we can barely make ends meet as it is.”