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Shifting care from hospital to community requires 'whole system approach'

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Health bodies have joined forces to reiterate the case for moving care from hospitals to community services.

The NHS Confederation, patient organisation National Voices and the Academy of Medical Royal Colleges are calling for 'more meaningful' engagement in how health services are arranged and changed with all those groups who are impacted by them.

Their report published last week says past experience of NHS changes, which can be driven by financial or clinical crisis, has polarised the debate to the extent that the service risks being paralysed, even though major change is essential for its successful future.

This new report, Changing care, improving quality, says rising demand and limited resources mean the reorganisation of services is essential for the NHS to remain sustainable and to continue providing safe, effective clinical care that meets patients' needs. It says that the term "reconfiguration" has become loaded with negative meaning, associated with making cuts and downgrading services, and that service changes are frequently viewed by the public as a threat rather than positive and necessary reforms.

The report says that making the case for change must happen earlier and that public and patients need to be fully involved from the outset. It emphasises the importance of a whole-system approach so that communities do not perceive change as a loss but understand how reinvestment in community-based services will deliver the quality and access they prioritise.

Mike Farrar, chief executive of the NHS Confederation, said: 'More than two-thirds of NHS Confederation members have told us 'political resistance' is the biggest barrier they face in relation to successful service reconfiguration. But political courage by itself is not enough to deliver the kind of change that the NHS needs at this point in its life; the service itself must overcome its paralysis in relation to change, and it must bring the right people with it.

'It is not good enough to say that it is 'difficult' to communicate the need for change to the public. Local people who use and rely on NHS services, whether they are regular service users or just count on it being there if they need it, deserve to have safe, sustainable health services. 'Tweaking' bits of the system in isolation from each other or changing only in response to external pressures will not deliver the long-term change we need for the NHS's survival.

'The onus is on us in the NHS to build the case for change amongst the people we need support from, so that 'reconfiguration' stops being a dirty word and starts to represent the kind of planned, well-evidenced change programme which the NHS deserves.'

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