Chris Hornung, Managing Director – Public Sector at Totalmobile, discusses how at-home care must become a central pillar of health policy to relieve pressure on the NHS.
When the government released its long-awaited 10-Year Health Plan this month, headlines focused on GPs, waiting times, and workforce investment. On paper, the ambition was welcome: shift care out of hospitals, treat people earlier, and move more services into communities. But for those working in the system, there’s one service area that still feels overlooked. Care at home.
If we want to take real pressure off our acute services, we can’t treat care at home as an add-on. It needs to become a central part of how we manage health.
Why care at home needs to be the front line
For decades, the NHS has been trapped in a reactive model, scrambling to treat illness once it reaches a crisis point. But care at home flips that logic. It’s about managing long-term conditions earlier. Preventing deterioration. Keeping people well enough not to need a hospital bed at all.
We now have the technology to do this well. People can track their own blood pressure, oxygen levels, and mobility from home and be alerted if something’s not right. But this isn’t about replacing people with machines. It’s about creating the conditions for earlier, better care, without needing a hospital stay. The NHS Fit For the Future plan talks about “closer to home” models, but doesn’t go far enough in making home-based care the default.
A gap in the funding conversation
What the plan doesn’t address clearly is how this shift will be funded. Yes, we’re seeing more talk about community health. But in England, much of that work is commissioned by local authorities, not the NHS.
At the moment, there’s little sign that local authorities will get the extra support they need to make this work. Most adult social care is delivered by private providers, commissioned locally. If we’re serious about care at home, we have to fund local authorities to commission and monitor that care properly.
Otherwise, we risk creating a pipeline out of hospitals with nowhere for people to go. For instance, this year, 13,000 beds a day were occupied by patients medically fit for discharge, slowing patient flow and leading to bottlenecks in service.
What good could look like by 2035
A strong at-home care model is about more than just devices. It’s about designing a system that’s flexible, responsive, and person-centred.
Right now, many people receive a fixed “package of care” that doesn’t change, even when their needs do. That’s not the fault of the care providers, but the system currently in place, but that’s not how health works in real life. People have good weeks and bad weeks. They recover, relapse, and improve again.
What we should aim for is real-time care planning. We’re working with several local authorities to build a system where carers can record someone’s daily condition – how they’re managing meals, hygiene, and mobility – and adjust their support accordingly.
If someone’s doing well, reduce visits. If they catch a cold or show signs of decline, increase support early before a hospital trip becomes necessary. These small, real-time changes can make a big difference. They’re better for the patient, and they cost far less than emergency care.
This approach has also been backed by a recent clinical trial published in The Lancet, which found that flexible home care packages led to a 35% reduction in unplanned hospital visits, leading to an average saving of £586 per person to the NHS over the year of the study.
The role of technology
Ultimately, technology should support the people who deliver care, not complicate their work.
Take continuity. We know it matters that people see the same carer when possible. But that’s not always realistic. Staff have holidays and sick days. What matters then is that whoever steps in understands the person they’re visiting.
For instance, we’ve recently piloted a tool that condenses six months of care records into a short, clear summary. A carer can read it in two minutes and walk in already knowing what’s changed, what to expect, and how best to help. That gives confidence to the carer, reassurance to the person receiving care, and flexibility to the service.
It’s a small feature, but it shows what thoughtful technology can do – remove friction and improve care.
What needs to change now
We need to stop dividing funding into NHS and local authority pots. It doesn’t reflect how people live. Someone recovering from surgery at home doesn’t care who’s funding their physio or their meals; they just need it to work together so they can get the support they need.
We should treat health funding as one national pot. Decide what we want to spend on hospitals, on community care, and on care at home and allocate accordingly. Right now, we’re seeing money flow into one part of the system while another is left short. That isn’t sustainable.
The vision in the NHS 10-Year Plan is the right one. But without real investment in care at home, we’re asking hospitals to do too much, too late.
We have a chance now to shift the system before it breaks. That means giving people the support they need, where they live and using technology to make that care smarter, faster, and more human.
If we get care at home right, everything else starts to work better.
About the author
Chris is committed to driving change in this sector, empowering Public Sector organisations to improve the quality and volume of their services. Chris brings over 15 years of experience in the sector, working with some of the UK’s largest NHS social and health care providers, as well as private health and social care organisations.
