Reducing avoidable hospital based care: re-thinking out of hospital clinical pathways

Improving health outcomes, preventing serious illness, providing convenient, timely and cost effective care, and avoiding the unnecessary use of acute hospitals, is a shared goal across the NHS, and requires a radical re-think about how and where care is delivered, for both acute and long term conditions. The design and implementation of high quality community-focused clinical pathways now requires the full range of health and social care professionals and their organisations to work together, alongside patient and public partners. New ways of working are required that maximise the impact of available staff, facilities and resources, and creative and innovative but realistic models of care need to be implemented.

This report is intended as a guide for all stakeholders to improve clinical pathways and develop models of care that are less dependent on acute hospitals. Its recommendations are relevant to both acute and long term condition pathways. The report provides a detailed guide to managing acute symptoms and acute conditions out of hospital where safe and appropriate to do so. It also provides detailed guidance on effective common city based pathways for three common long term conditions: heart failure, respiratory conditions and patients living with and beyond cancer.  

The key requirements for and potential of community based clinical hubs are also described.

This report complements the Urgent and Emergency Care Review and its ‘Safer, Faster, Better' report, and anticipates some of the learning expected from the national Five Year Forward View vanguard sites that relate to joined up working between primary, community and hospital care.  

Download report