As people are living longer with multiple, complex and long-term health issues, they can encounter challenges in accessing the essential primary care, social support and community-based services necessary for managing these conditions. Consequently, they might not receive treatment until their conditions have progressed to a more critical stage (Wickens, 2023). Improving access to out-of-hospital care must not be seen solely as a policy goal; it is a necessity. The NHS Long Term Plan (NHS England, 2019) asserts that the NHS will boost out-of-hospital care and finally end the historic divide between primary and community health services.
NHS England envisions a system where high-quality primary and community services can effectively diagnose, monitor and manage conditions, and unnecessary hospital admissions can be prevented. The aspiration in the NHS Long Term Plan is that community services – such as community nursing, rehabilitation and end-of-life care – will be expanded, and more integrated with primary care and other local services to provide a seamless patient experience.
A commitment has been made to increase funding to support the delivery of more care outside of hospitals. This includes investing in workforce development and new models of care delivery to improve access and quality of care. A need to use more digital and technological solutions, such as telehealth and remote monitoring, to improve access to care and to support patients to manage their health at home is a key component. Virtual wards, for example, represent transformational, innovative healthcare solutions where patients receive hospital-level care at home, leveraging technology for daily monitoring, which increases capacity and potentially improves patient outcomes (Department of Health and Social Care, 2023).
Although initiatives such as virtual wards offer numerous benefits by providing hospital-level care at home, increasing efficiency and potentially improving patient recovery, they also present several challenges. Technological barriers, for example – not all patients have access to the necessary technology or the internet, creating disparities in care, and it should be noted that not all NHS technology is fit for purpose (Mistry, 2024). This is complicated by low technological literacy, which means nurses and patients may struggle to use digital tools required for virtual care effectively. Workforce issues are also significant. Nurses and other health professionals need education and training to effectively use new technologies and adapt to remote care practices. The move to virtual care can change workload dynamics, possibly leading to new types of stress or burnout. Financial and resource constraints are also considerations. Setting up virtual wards requires significant initial investment in technology, infrastructure and staff and patient preparation. Securing sustainable, long-term financial support for virtual care services can be challenging, especially in healthcare systems that are facing financial constraint or budget limitations.
Supporting people to stay healthy and independent for as long as possible through preventive measures and early interventions, are key components of out-of-hospital care provision. This includes supporting people with long-term conditions to manage their health at home and providing more support for carers.
Improving access to out-of-hospital care in the UK is not only a moral imperative but also a practica necessity. Reforming out-of-hospital care services to be more integrated, well-resourced and focused on prevention, has the potential to ensure that all patient have access to the care they need, when they need it, ultimately improving health outcomes and reducing the burden on the NHS.