New Nuffield Trust report: International lessons on moving care closer to home

Today the Nuffield Trust has published a new report: From Hospital to Community: International lessons on moving care closer to home, which has been covered in a Financial Times exclusive.

As the NHS moves towards implementing the 10 Year Health Plan and works to reduce its over-reliance on hospitals, there is an important opportunity to learn from other countries that have pursued similar reforms.

The research explores Denmark and the Republic of Ireland's efforts to shift more care out of hospital - both of which have committed to bold, long-term strategies to rebalance care towards communities. Denmark is just at the start of its reform, whereas Ireland is nearly a decade in. The research was based on interviews with Danish and Irish experts earlier this year as well as a structured review of policy documents and literature coming out of both countries

There are valuable lessons that England should listen to if this key part of the government's 10 Year Health Plan is to be a success, including:

• In Denmark and Ireland, shifting care has not meant cutting hospital budgets – it has meant expanding community capacity in parallel.
• Shifting care is not just about moving money – it is also about moving staff, which in other countries has required contractual changes and new funding mechanisms.
• Cross-party political consensus and commitment have been crucial to reforms in Demark and Ireland. The absence of these may derail efforts in England.
• Disjointed policy-making has at times weakened reform efforts in Denmark and Ireland – reinforcing how shifting care is hard to sustain and only works when decisions are aligned across the whole system.
• Reforms in Denmark and Ireland have been preceded by significant capital investments in hospital and community settings (for things like buildings and equipment) – providing a foundation for reforms that does not exist in England.
• Coming up with a plan is only the start – Denmark and Ireland have been much clearer on the ‘how' of change than England so far. We'll also need clear accountability and measurement to understand the impact of reforms.