An in-depth review of NHS data has revealed that patients occupying hospital beds beyond their medical needs are costing the health service upwards of £200 million each month. These individuals, though ready for discharge, remain in hospitals due to a lack of appropriate community care options. Consequently, hospital beds are filled with patients who no longer require them, causing others to endure waiting in corridors or ambulances for necessary treatment.

This scenario is a recurring issue every winter, highlighting the imbalance within the health and care systems. Hospitals are not only overcrowded due to seasonal illnesses or increased admissions but also because the communities lack sufficient infrastructure to support individuals once they are ready to leave hospital care.

In a recent conversation, a colleague shared the story of her 92-year-old mother, who has been hospitalized for several weeks. Although she no longer requires acute medical attention, she cannot be discharged due to the local authority’s inability to arrange community support. On her ward, each of the six beds is occupied by elderly patients whose conditions could be adequately managed at home with proper mobility assistance, medication reminders, and basic care like washing and meal preparation. These are six individuals eager to return home, and six beds unavailable for new patients. When this situation is multiplied across numerous hospitals, the enormity of the issue becomes apparent.

Year after year, the narrative remains unchanged: hospitals at capacity, ambulances queued up, and families left in distress. Yet, the system continues to prioritize hospital-based care—the most costly and least efficient aspect—instead of community-based solutions that could maintain individuals’ health from the outset. The cost of a hospital bed exceeds £400 per night for the NHS, while quality community care is significantly less expensive and promotes activity, independence, and connection to loved ones and familiar surroundings. This is not solely a financial argument but also a humanitarian one, as no one desires to age in a hospital ward.

It’s time to redefine the concept of “care” in the modern age. Care should not commence only when individuals reach a critical state; it should be rooted in homes and communities, where minor interventions can prevent major issues. This calls for alleviating pressure on hospitals by instituting a National Community-First Strategy—a comprehensive plan to realign the system towards prevention, independence, and local collaboration.

A Community-First Strategy would entail three key components: firstly, the establishment of integrated local teams of health and care professionals—including community nurses, care workers, GPs, therapists, and voluntary organizations—who collaborate to support individuals prior to reaching a crisis. These teams would possess an in-depth understanding of their local populations, utilize shared records, and be empowered to respond swiftly to emerging needs.

Second, it would harness technology and data to spot early signs of decline. Smart monitoring, remote testing and digital health tools are already transforming outcomes in some areas. When used properly, they mean small issues like dehydration, falls risk or a urinary infection can be picked up before they turn into hospital admissions.

Third, it would raise the status of the care professionals. The people who enable others to live well at home should have the same professional development and public respect as their NHS counterparts. 

Right now, too many leave the sector because they can’t build a career in it – yet they are the very people who can unlock the hospital discharge gridlock.

And crucially, funding must follow the person, not the setting. Whether support comes through the NHS, a local authority or a private provider, the money should flow to where people’s needs are best met  – often in their own home. Above all, families tell me they want choice: choice over how care is funded, and how and by whom it’s provided.

None of this is radical. It’s common sense, long overdue and supported by decades of evidence. Countries that invest in community-based care reduce hospital pressure, cut costs and improve life expectancy. 

Here in the UK, we already have good examples: integrated discharge teams, step-down units and virtual wards that combine NHS and social care resources to help people recover safely at home. But these are the exceptions, not the rule.

If we truly want to relieve pressure on hospitals and improve people’s lives, we must start by building care around communities – not wards. That means preventing crises before they happen, supporting independence for longer, and keeping people connected to family, friends and the places they know best. The hospital of the future won’t be defined by four walls and a bed. It will begin at the front door of your own home.

Martin Jones MBE is CEO of Home Instead UK & International