Responding to healthcare demand by shifting care closer to home

• Health systems are having difficulty coping with healthcare demand, and there is a shift in the management and treatments of conditions toward patients as consumers
• The ambition to deliver more healthcare closer to home is a critical response to mounting pressures on health systems
• There are significant challenges to be overcome to successfully shift care from hospital settings to community environments, including patient engagement, workforce adaptation, technological integration, and the need for more accessible solutions

Across the world, there is growing healthcare demand along with a global shortage of healthcare staff.¹ The demand side is largely driven by an aging, less healthy population coupled with significant growth in multi-morbidity.² Patients presenting multiple conditions add complexity to the patient-clinician relationship, and at the same time, add immense financial burden to healthcare systems.³ On the supply side, the global shortage of healthcare staff means that the industry must find alternative solutions to satisfy the growing healthcare demand.

Further compounding the demographic crisis threatening the stability of healthcare systems, there is also a cultural shift. Patients are now mature consumers in every other aspect of their lives, and they increasingly see healthcare with the same lens. This means that patients have come to expect the ease and accessibility that comes with other services—digital delivery, immediacy, and personalization (think Netflix/Spotify, Strava, Amazon).⁴

This “consumerisation” is shifting the power dynamic between clinicians and patients, more often towards the patient and away from the clinician.

Under the weight of these factors, health systems are having to find ways to serve the “unhealthy consumer,” since health systems can no longer resolve the healthcare demand and supply imbalance without making fundamental changes.

Across the healthcare ecosystem, these challenges are being met in part by increasing the use of digital tools and making efforts towards delivering care closer to home, sometimes referred to in the European Research community as “Stay Left, Shift Left.”⁵ The contention is that at-home care will improve the quality of care and reduce demand and costs. 

In the UK, for example, the Government has responded by saying that it will focus on 3 strategic shifts:⁶

• Hospital to community
• Sickness to prevention
• Analogue to digital

The aim of these shifts is to:

• Cut waiting times for care
• Reduce the amount of time spent in ill health
• Tackle health inequalities
• Reduce lives lost to the biggest killers: cancer, cardiovascular disease, and suicide
• Make the NHS sustainable in the long term

This leaves the question: What approaches are needed to enable a successful transition to increased care in the community, and how can we give ourselves the best chance possible to deliver the results that are required? Realizing this vision requires navigating a complex web of interconnected challenges.

As noted, a significant and growing portion of the aging population in developed countries live with multiple long-term conditions.⁷ In the UK, for example, one in 4 adults has at least 2 health conditions.⁸

Managing these complex needs outside of a hospital setting demands sophisticated coordination of care, robust patient support systems, and accessible information tailored to individual circumstances. The increasing age of the population further exacerbates this challenge, often requiring more intensive and integrated community-based services.

Shifting care closer to home necessitates a fundamental shift in the patient-provider relationship. Patients need to be empowered with the knowledge, skills, and confidence to manage their health and conditions effectively at home.⁹ This requires:

• Accessible and understandable information: Providing clear, concise, and multilingual information about conditions, treatments, and self-management strategies.
• Support for self-management: Equipping patients with the tools and resources to actively participate in their care, including symptom tracking, remote monitoring, and access to support networks.
• Addressing diverse needs: Recognising and responding to the unique needs and preferences of patients with multiple conditions, multiple languages, and varying levels of health literacy.

Some groups and communities are more likely to experience poorer health than the general population.¹⁰ These groups are also more likely to experience challenges in accessing care. The reasons for this are complex and may include:¹¹

• The availability of services in their local area
• Service opening times
• Access to transport
• Language (spoken and written)
• Literacy

To address this issue in the UK, the Government has established the Core20PLUS5 programme and called for the development of digitally enabled care pathways to increase inclusion.¹² Shifting care closer to home must actively address these challenges, ensuring that services are culturally sensitive, linguistically appropriate, and readily accessible to all.

Healthcare ecosystems are often made up of numerous independent institutions, each with their own operational procedures and technological infrastructure. Achieving a seamless transition of care from hospitals to the community requires significant improvements in interoperability and data sharing across these disparate entities.¹³ Standardizing protocols while allowing for local adaptation to meet specific community needs presents a delicate balancing act.

Digital technologies are widely recognised as crucial enablers of delivering care closer to home. However, the successful adoption and integration of these technologies present their own set of challenges. These include:¹⁴

• Developing flexible and interoperable platforms: Creating digital tools that can seamlessly connect patients, community services, primary care, and hospitals is essential. These platforms must be able to support multiple conditions and treatment pathways and adhere to local requirements.
• Ensuring inclusion: Strategies must be in place to support those who do not speak the national language or have limited digital literacy, ensuring that the digital shift does not exacerbate existing health inequalities.
• Data security and privacy: Robust systems are needed to ensure the security and privacy of patient data as it is shared across different care settings and digital platforms.
• Meaningful data collection and utilization: Effectively capturing and utilizing patient-reported data, as well as data from remote monitoring devices, requires a robust data infrastructure and analytical capabilities to inform clinical decision-making for individual patients and population health management.

A significant shift in care delivery will require a corresponding adaptation of the healthcare workforce.¹⁴ This includes:

• Upskilling and training: Equipping healthcare professionals with the skills and knowledge to effectively deliver care in community settings, utilise digital tools, and support patient self-management.
• New models of care: Developing and implementing innovative models of care that facilitate seamless collaboration between hospital-based specialists, primary care providers, and community health services.
• Addressing staffing challenges: Ensuring adequate staffing levels in community settings to meet the increasing healthcare demand for out-of-hospital care.

Delivering more healthcare closer to home holds immense potential for improving patient outcomes, enhancing efficiency, and promoting more sustainable healthcare systems.  However, realising this vision requires a concerted effort to overcome significant and interconnected challenges.

Addressing the complexities of multi-morbidity, tackling deep-rooted health inequalities, fostering seamless integration across a fragmented system, strategically leveraging digital technologies while ensuring inclusivity, empowering patients through education and support, and adapting the healthcare workforce are all critical prerequisites for success.

Acknowledging and proactively addressing these multifaceted challenges is paramount to achieving a truly transformative and patient-centered healthcare system that delivers care closer to home for patients, carers, and the health system.