Shifting the balance of care: Great Expectations

This Nuffield Trust report forms part of their work programme on new models of care, and also contributes to their ongoing work on Sustainability and Transformation Plans (STPs). With the need to move care from hospital into the community a core part of STP plans across the country, a review of the evidence is both timely and necessary.

This research draws on an extensive literature review to assess the realism of the narrative that moving care out of hospital will save money. It sets the context of this through analysis of hospital activity data over ten years. The literature review focuses on initiatives that were expected to impact on hospital care, as this is what STPs predominantly focus on. Nuffield Trust explores these by looking at five key areas: elective care, urgent and emergency care, admission avoidance and easier discharge, at risk populations, and self-care.

This report aims to inform the development of STPs to ensure that they are drawing on the best available evidence. It also seeks to dispel some widely held myths about the ‘magic bullet’ of shifting care into the community.