The authors of a new report from The King’s Fund, ‘Making care closer to home a reality’, say failure to grow and invest in primary and community health and care services – despite successive governments stating a commitment to this agenda – is ‘one of the most significant and long-running policy failures of the past 30 years’.
Beccy Baird, Deborah Fenney, Danielle Jefferies, and Dr Andy Brooks, say England’s health and care system in must be ‘radically refocused’ to put primary and community care at its core to be effective and sustainable – with a ‘need for clear vision, with funding, staff and political energy directed at general practice, pharmacy, community services, and social care’.
Despite ‘the vast majority’ of interactions with the NHS being via primary and community services, with an average of 876,164 GP NHS appointments a day in the NHS, (up 34,219 since 2018/19), and ‘repeated pledges to boost out-of-hospital care’, the proportion of Department of Health and Social Care (DHSC) spending on primary care has fallen – from 8.9% in 2015/16 to 8.1% in 2021/2.1 In 2021/22 the largest proportion of DHSC spending, £83.1 billion, went to acute hospitals, compared with £14.9 billion on primary care. Acute hospital Trusts have seen 27% funding growth since 2016/17, but community Trusts have received half that level. Equally, NHS consultants numbers rose by 18% between 2016/17 and 2021/22, with just a 4% increase in GP numbers. ‘A significant jump’ in social care staff has seen vacancies rise from 110,000 in 2020/21 to 152,000 in 2022/23.
Seeking the key reasons for this ‘longstanding policy failure’, the researchers found progress had been hampered ‘by an incorrect belief that moving care into the community will result in short-term cash savings’. Other factors include a lack of data about primary and community services, leading to a ‘cycle of invisibility’, funding flows that prioritise hospitals, and ‘urgent challenges’ such as A&E waiting times and planned care backlogs becoming the priority for politicians ‘tempted by quick fixes, instead of fundamental improvement’.
The King’s Fund says bolstering primary and community care should not mean closing hospitals; England already has fewer hospital beds per capita than other nations. They advocate prioritising investment in primary and community care buildings and equipment, and ‘cutting red tape so organisations can better pool the space they have’.
Chief Executive, Sarah Woolnough (pictured), said: “The answer to overcrowded hospitals is not more hospitals. Despite this being well understood for many years, there is now a higher proportion of the NHS budget and staff going into hospital services. Simultaneously, there has been a slow erosion of capacity and confidence in primary and community care.”