Clinical homecare can do more for the NHS, if we design around the whole pathway
The opportunity for clinical homecare is growing. As the NHS looks to make better use of hospital capacity, more care can potentially be delivered outside traditional settings, but moving treatment into the home is only part of the answer. The bigger opportunity is to rethink the whole patient pathway, involving patients from the beginning of service design and considering where care can be delivered most effectively, how information moves between organisations, who is accountable for outcomes and how value is measured across the system.
That was a recurring theme in the recent Homecare and the Changing NHS webinar, which brought together NHS and clinical homecare leaders, including Sciensus’ Susan Gibert, to consider the sector’s role in the 10-Year Health Plan.
The discussion reinforced something we see increasingly in our work with NHS partners: clinical homecare can make a meaningful contribution to patient experience and NHS capacity, but its full value is realised when it is designed as part of the wider care pathway rather than treated as a standalone service.
Start with the pathway, not the setting
Conversations about homecare can easily become focused on where treatment takes place: hospital or home. In practice, the more useful starting point is to involve patients at the beginning of service design, understand what they need at each stage of their journey and identify which parts of that pathway genuinely require a hospital setting.
For some patients, this may mean receiving an infusion at home. For others, it may involve learning to self-administer treatment, completing monitoring remotely or having elements of clinical review delivered outside hospital. The opportunity is different for every pathway.
The webinar highlighted the potential for greater local flexibility to help NHS systems design services around the needs of their populations. That flexibility could support more appropriate use of clinical homecare, but it also makes clear accountability increasingly important.
If responsibility for a pathway is spread across multiple organisations, someone still needs to have sight of the whole patient journey and the authority to improve it. Local flexibility also needs to sit alongside consistent expectations around safety, quality and outcomes, so differences in how care is delivered do not translate into differences in the standard of care patients receive.
Measure value across the health system
A narrow comparison of the cost of delivering an individual intervention in hospital versus at home will only tell part of the story. The webinar discussion repeatedly returned to the need to understand value across the wider system.
That means considering whether a different care model can reduce pressure on outpatient services, avoid unnecessary hospital attendances, shorten stays or release clinical capacity. But the value does not stop at the capacity created. The more important question is how that capacity can then be used.
When appropriate care is delivered outside hospital, scarce hospital resource can be focused more deliberately on the patients, interventions and services that genuinely need it. Released capacity can be reinvested in specialist care, more complex patients, faster access or areas where demand continues to outstrip supply.
This is an important shift in how we think about efficiency. The objective is not to do the same work with fewer resources. It is to use the resources available across the system more intelligently, protecting hospital capacity for the work only hospitals can do.
The same broader view applies to patients. Value can include spending less time travelling to appointments and being better able to remain in work, education or family life. These outcomes may sit outside the immediate cost of an individual intervention, but they are part of the overall impact of redesigning the pathway.
Digital should connect the pathway
The same principle applies to digital transformation. Replacing a paper process with an electronic one can improve efficiency, but the greatest benefit comes when digital systems make the whole pathway easier to manage. That requires information to move appropriately between the clinical team, prescriber, pharmacy, homecare provider and patient.
When those parts of the pathway remain disconnected, teams may still need to chase information manually, duplicate activity or work without a complete view of what is happening to the patient.
Better interoperability and appropriate data sharing can change that. Giving teams greater visibility across the pathway can reduce administrative work, support better coordination and help identify issues earlier.
The emphasis should therefore be on solving practical problems for patients and clinical teams, with technology supporting the pathway rather than defining it.
Partnership has to go beyond delivery
The evolving role of clinical homecare also changes what good partnership looks like. Independent providers can bring clinical expertise, digital capability and additional capacity, but those capabilities are most useful when they are integrated with NHS services rather than operating alongside them.
That means developing pathways with NHS teams, understanding local pressures and adapting support around the needs of individual services. It also means being clear about where responsibility sits and ensuring NHS clinical teams retain the oversight they need.
Across our work at Sciensus, we are increasingly seeing opportunities to support much more than the delivery of medicines. This can include additional prescribing capacity, digital assessment and monitoring, and new pathways that allow appropriate treatment and support to move closer to home.
The common thread is the same: start with the pressure or problem within the pathway and work backwards to the capability needed to solve it.
The next phase of clinical homecare
The 10-Year Health Plan creates an opportunity to think more broadly about the role clinical homecare can play.
The webinar showed there is considerable appetite for that conversation. It also highlighted the conditions needed to turn ambition into meaningful change: clear pathway ownership, a broader view of value, connected digital infrastructure and genuine collaboration between NHS teams and their partners.
Clinical homecare can help create capacity and give patients greater flexibility over where they receive care. Its wider potential comes from helping redesign pathways with patients involved from the beginning, allowing scarce hospital capacity to be focused where it adds the greatest value and supporting the NHS to use its people, places and resources more effectively.
