NHS Community Care Shift: Preparing for Home-Based Care in England

England's health and social care system is undergoing a major transformation. The NHS is moving towards more community and home-based care, reducing reliance on hospitals and improving patient outcomes.

At the same time, the Care Quality Commission (CQC) continues to highlight system fragmentation and pressure across services.

For commissioners and care managers, this shift presents both opportunity and risk. Strategic planning will be essential to ensure care is safe, equitable, and sustainable.

The move towards NHS community care is driven by both patient outcomes and system pressures:

• Over 53% of the public see reducing hospital pressure as the biggest benefit
• Long hospital stays can reduce independence and delay recovery
• Home-based care improves patient experience and long-term outcomes
• Programmes like Building the Right Support have enabled nearly 10,000 people to move into community settings

This shift reflects a broader move towards person-centred care closer to home.

Despite progress, several challenges are slowing the transition to home-based care in England:

• Workforce shortages: Social care vacancies are significantly higher than the wider job market
• District nursing decline: Capacity has fallen by around 50% over the past 14 years
• Homecare gaps: A major contributor to delayed hospital discharge
• Mental health demand: 1 in 3 people wait over three months for support

These pressures highlight the need for effective commissioning strategies.

1. Build Capacity in Community Services

To support the NHS community care model, commissioners should:

• Invest in reablement, rapid response, and homecare services
• Strengthen multidisciplinary community teams
• Support workforce recruitment, training, and retention

2. Improve Digital Integration

Digital infrastructure is critical for safe, joined-up care:

• Prioritise shared care records (69% of the public report increased confidence)
• Ensure interoperability across NHS, social care, and voluntary sector systems

3. Reduce Health Inequalities

Community care must be inclusive and accessible:

• Commission services based on local population needs
• Engage underrepresented and seldom-heard groups
• Improve access for autistic people, people with learning disabilities, and those in deprived communities

4. Strengthen Hospital Discharge Pathways

Delayed discharges remain a major challenge:

• Expand community capacity to reduce the "6 in 10" delayed discharge rate
• Commission flexible, personalised care packages
• Embed life planning for individuals transitioning from hospital to home

5. Support Innovation in Home-Based Care

Innovation will play a key role in scaling community care:

• Virtual wards and remote monitoring
• Person-centred support models such as the Small Supports Programme
• Community hubs like The Beehive

The shift towards community and home-based care in England is essential for the future sustainability of the NHS.

However, success depends on:

• Strong commissioning leadership
• Long-term investment in community services
• Effective collaboration between providers

With the right approach, we can deliver local, personalised care designed around people—not the system.

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