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Commissioning out of hospital care services to reduce delays

Discussion paper | March 2020

Visitng Professor John Bolton has taken the opportunity of working from home to update and refresh his work on out of hospital care. Many Hospitals have been creating space for patients with the COVID-19 by looking to speed up the discharges for patients who no longer need hospital care. This guidance is timely in offering a strategic approach to this. This guidance builds on work undertaken with several health and care communities across the United Kingdom. In particular it draws on recent work commissioned by the NHS Delivery Unit in Wales and with the Local Government Association in England.

The paper offers a structured approach to understanding demand, supply and impact of our out of hospital care systems through a data collection template and proposition for a 'model' for describing the service elements which make up 'intermediate care services'. It looks in detail at the services that are most likely needed in order to build an effective set of intermediate care services and the quantity of that service that may vary from place to place. At its heart it introduces an approach to outcome based commissioning that is both efficient and effective.