Bending the Spend: What prevents commissioners from spending more on out-of-hospital care?

The long term plan for the NHS is to increase the amount of care provided in the community instead of in hospitals where this is possible. However, little progress has been made against this aim over the past decade. Our recent work in Greater Manchester shows how difficult it can be for local systems to shift their spending in line with such policy aims.

To better understand spending choices by identifying what influences the amounts spent on prevention, primary care and community services, and to identify where opportunities exist to shift these spending patterns.

We will analyse historical data on spending by sector (primary, secondary, and community) by Clinical Commissioning Groups, and current data on spending by Integrated Care Systems. We will link this to data on workforce volumes and staff composition, as these are main drivers of spending.

We will use statistical methods to examine how much spending patterns differ across different commissioning organisations in England, and the trends in this spending by sector over time. We will then examine the system influences on these spending patterns, and whether they are affected by the introduction of formal powers to pool funds across sectors.

These results will be relevant to national policymakers and advisors, the NHS England payment systems and incentives team, and senior managers in Integrated Care Boards.

We will discuss regularly with people in the Department of Health and Social Care and NHS England, to share findings and inform development of guidance on resource shifting.