• Making better use of data and digital
technology. The NHS will provide more
convenient access to services and health
information for patients, with the new NHS app
as a digital front door, better access to digital
tools and patient records for staff, and
improvements to the planning and delivery of
services based on the analysis of patient and
• Getting the most out of taxpayers’ investment
in the NHS. Working with doctors and other
health professionals to identify ways to reduce
duplication in how clinical services are
delivered, make better use of the NHS combined
buying power to get commonly used products
for cheaper, and reduce spend on
Integrated Care Systems
The NHS Five Year Forward View published in
2014 established Sustainability and
Transformation Partnerships (STPs). STPs are now
evolving into Integrated Care Systems (ICSs).
Within the current legal framework, the NHS
and its partners will be moving to create
Integrated Care Systems everywhere by April
2021, building on the progress already made. ICSs
bring together local organisations in a pragmatic
and practical way to deliver the triple integration
of primary and specialist care, physical and
mental health services, and health with social
care. They will have a key role in working with
Local Authorities at place level, and through ICSs,
commissioners will make shared decisions with
providers on population health, service redesign
and long-term plan implementation. ICS will
deliver the aims set out in the NHS long-term
a new service
on primary and
and changes in
Moving care closer to people’s homes and
Frimley STP’s North East Hampshire and Farnham
Vanguard brought together primary, community,
acute, mental health and social care service teams
across the area to work as one. Closer working
across traditional service boundaries helped to
stimulate new services and initiatives, which
support people, to manage their own health and
care more effectively and to receive more care
and support in their local community rather than
This includes the Time Out café in Aldershot
for people with mental health problems, run
across geographical and organisational
boundaries to offer an alternative to A&E for
those in crisis. Service users can access the café
seven days a week with no appointment needed,
to get support from staff, learn self-management
skills and use community resources such as peer
support and mental health and wellbeing advice.
The scheme has resulted in a reported 33%
reduction in acute psychiatric admissions.
Residents’ feedback shows they particularly value
being able to access help when they need it and
that the café has helped to avoid further crisis,
self-harm and unnecessary A&E visits.
Other examples include GPs in Erewash are
supporting urgent care through an on-day service
that has contributed to a 3.8% fall in non-elective
admissions to hospital, despite overall rising A&E
attendances. In Dudley, teams of doctors, nurses
and other professionals have reduced the time
people spend in hospital by the equivalent of 900
bed days in just over two years. Pharmacists,
working alongside teams in local GPs’ surgeries,
have helped reduced mortality from
• Further case studies and examples can be
Could you present two/three elements on
the impact of such reforms on hospital and/
or healthcare sectors that your organisation/
country has identified?
Following three years of testing alternative
models in the Five Year Forward View through
integrated care Vanguards and Integrated Care
Systems, we now know enough to commit to
a series of community service redesigns
everywhere. The Vanguards received less than
one tenth of 1% of NHS funding, but made
a positive impact on emergency admissions,
and demonstrated the benefits of proactively
identifying, assessing and supporting patients at
higher risk to help them stay independent for
1 For more information on the Danish National Strategy for
Personalised Medicine 2017-2020 click here.
2 For more information about the National Digital Health Strategy
2018-2022 click here.
3 The reply was provided in January 2019. The reform mentioned
did not receive the approval on the Finnish Parliament and the
Government resigned in March 2019. Ministério da Saúde (2018),
Retrato da Saúde, Portugal. Available here.
4 Portaria n.º 71/2018. Available here.
5 For further information click on the following link.
6 Ministério da Saúde (2018), Retrato da Saúde, Portugal.
7 Estratégia Nacional para o Ecossistema de Informação de Saúde
2020 (ENESIS 2020). Available here.
8 Web-portal available here.
9 Mobile application MySNS available here.
10 Mobile application MySNS TEMPOS available here.
11 Mobile application MySNS CARTEIRA available here.
12 Decreto-Lei n.º61/2018 available here.
Total current health expenditure as % of Gross Domestic Product (GDP)
General government/compulsory current health expenditure as % of total current health expenditure
Hospital current health expenditure, as % of total current health expenditure
Household out-of-pocket health expenditure as % of total current health expenditure
All hospital beds per 100,000 inhabitants
Acute care hospital beds per 100,000 inhabitants
Acute care admissions/discharges per 100 inhabitants
Average length of stay for acute care hospitals (bed-days)
Practising physicians per 100,000 inhabitants
Practising nurses per 100,000 inhabitants
HHE 2019 | hospitalhealthcare.com