As the NHS rethinks where specialist care should happen, established clinical homecare services could play a greater role in transforming patient pathways and supporting NHS capacity.
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The NHS’s ambition to move care out of hospitals and closer to patients is entering a new phase.
The 10-Year Health Plan for England prioritises care in patients’ homes where appropriate, neighbourhood health centres when needed and hospitals when necessary. Subsequent NHS planning guidance reinforces the ambition to deliver more specialist care closer to home.
But as NHS organisations redesign services, an important question emerges: are we making full use of the clinical capabilities already operating outside hospital walls?
Moving an outpatient clinic into a community building relocates the appointment. It does not necessarily change the model.
If we were designing specialist care pathways from scratch today, would we really default to repeated outpatient attendance?
For some patients and treatments, hospital attendance remains essential. For others, established models of care could offer an alternative.
The challenge is not simply to change where care happens, but how it is designed and delivered.
Building on existing capabilities
Clinical homecare has supported NHS patients for decades. Yet it can still be perceived predominantly as a medicines delivery service.
This overlooks the specialist nursing, medicines management, patient education, adherence support, and operational expertise underpinning established services.
The National Clinical Homecare Association’s (NCHA) 2024 Best Kept Secret report estimated that more than 600,000 people received NHS-contracted clinical homecare across the UK, based on December 2023 data.
Its analysis also incorporated approximately 2.8 million annual medicines deliveries, illustrating the operational scale of services already supporting patients beyond hospitals.
The report estimated that annual clinical homecare activity was equivalent to the day-case elective capacity of approximately 15 NHS trusts. While this is a modelled comparison rather than hospital capacity directly replaced, it highlights the potential contribution of established services.
As neighbourhood healthcare develops, the opportunity is not simply to create new services, but to better integrate existing clinical capabilities.
Clinical homecare should be considered part of the healthcare infrastructure available to support specialist pathway transformation.
Designing pathways around patients
The objective should not be to move every treatment into patients’ homes, but to consider where each element of care can be delivered most safely and effectively.
A patient’s initial assessment and treatment may require hospital attendance. Once clinically suitable, elements of ongoing care could be supported through specialist homecare services, with appropriate monitoring and escalation arrangements.
Hospital, neighbourhood, and home-based services should complement one another according to clinical need and patient preference.
For patients, this can mean fewer journeys, less disruption, and greater independence.
The NCHA’s 2023 patient survey found that 62 per cent of clinical homecare respondents said receiving care this way had allowed them to remain in work or education.
The report also estimated that 75,000 clinical homecare patients avoided a 40-mile round trip with each medicine delivery, highlighting potential benefits for travel, time, and accessibility.
These findings illustrate how treatment arrangements can affect patients’ everyday lives, although reported benefits and modelled estimates should not be interpreted as guaranteed outcomes for every patient.
Supporting NHS capacity
For NHS organisations, appropriately designed pathways may also create opportunities to use workforce and hospital capacity more effectively.
The NCHA’s economic modelling estimated that clinical homecare saves approximately 900,000 hours of NHS nursing staff time annually, equivalent to 432 full-time nurses.
These are estimated capacity benefits, not directly observed reductions in staffing requirements. Nevertheless, they demonstrate the potential value of specialist nursing and operational capabilities working alongside NHS teams.
The ambition should not be to replace hospital care, but to make better use of the clinical capabilities available across the healthcare system.
Infrastructure must connect
Clinical homecare is not without challenges. The General Pharmaceutical Council’s 2025 review identified continued reliance on paper prescriptions, limited access to relevant clinical information, and opportunities to improve communication between organisations.
Addressing these challenges requires collaboration between NHS organisations and providers, alongside improvements in homecare services’ own digital capabilities.
Effective integration also depends on clear clinical accountability, patient safety arrangements, and timely communication.
Moving care outside hospital does not automatically remove pressure from the healthcare system. Sustainable benefits depend on pathways being designed deliberately.
From ambition to delivery
Four priorities deserve consideration as neighbourhood healthcare evolves.
- Recognise: Include established clinical homecare capabilities when planning neighbourhood services and redesigning specialist pathways.
- Integrate: Design care around clinical suitability and patient needs, using hospital, neighbourhood, and home settings appropriately.
- Partner: Strengthen collaboration between NHS clinical teams and homecare providers, supported by clear accountability and governance.
- Connect: Improve electronic prescribing, information sharing, and digital interoperability across organisations.
Moving care closer to home should mean more than relocating existing services.
Clinical homecare is not a complete solution to NHS pressures, but it represents established specialist infrastructure that deserves consideration as services evolve.
As the NHS invests in new models of care, perhaps the first question should not always be what new infrastructure needs to be built, but whether we are making full use of the capabilities already available.
