The health service could save more than £1bn each year by increasing the number of patients it treats at home rather than in hospital, according to a report seen by HSJ.

The report, which forecasts the results of planned service changes at one primary care trust, suggests that if the identified savings were replicated across England, the NHS could save between £540m and £1.2bn a year.

Published by Dr Foster Intelligence and private provider Healthcare at Home, the report looks at service changes being introduced by NHS Birmingham East and North and Healthcare at Home. They focus on providing a significant amount of services at home for long term conditions, end of life care, chemotherapy, and enhanced supported discharge.

Potential savings are:

  • £1.9m through enhanced supported discharge - up to £837m across England
  • £1.7m from avoiding unnecessary admissions for patients with long term conditions - up to £210m nationally
  • £420,000 by providing chemotherapy at home - up to £73m nationally
  • £1.2m by providing home based end of life care - up to £160m across England.

NHS Birmingham East and North chief operating officer Andrew Donald said the programme was intended to improve quality of care and increase preventive measures, as well as providing a return on the PCT’s investment.

Engaging Healthcare at Home to help redesign PCT services and provide detailed economic modelling required “bravery” from his PCT, said Mr Donald.

“It is not just about commissioning from different providers, but about strategic alignment with the partners you work with. We need to have partners that absolutely understand that we need to have a return on that investment.”

Mr Donald said the key to making significant savings was to ensure large numbers of patients used the new look services, and by discussing what could be removed from hospital infrastructure with secondary care colleagues.

“These savings can be replicated across the country if PCTs [will] be brave, innovative, and take a managed risk,” he said.

NHS Alliance chair Michael Dixon said that “having the will to push change through” would be the key to ensuring these sorts of savings were reproduced.

He said he would be “interested” to see private providers take the financial risk themselves on proposed savings from service redesign.

Primary Care Trust Network director David Stout said: “Follow through is the key in these situations, because you don’t actually save any money until you take out the capacity in the hospital sector. But this report does make a pretty persuasive case.

“‘The real difference here, compared to work going on elsewhere, seems to be scale. It’s a more ambitious attempt than most to redesign services for a bigger cohort of patients, and more quickly,” he said.