ARI 2: reduction of compound pressures on the NHS and social care

Research objective: Research to evaluate interventions to improve patient outcomes and reduce pressure across the health and care system through preventing avoidable admissions, innovations to make routine care more efficient and resilient, smart discharge, and through effective pandemic preparedness and new treatments to tackle a range of infectious diseases.

Priority research topics: Identifying factors across the system that drive admission, delayed discharge and readmission and using this information to design more effective and targeted interventions including systems approaches such as developing, evaluating and understanding:
- the role that all parts of the health system, from community and primary care through to hospital-based and social care, play in delivering better outcomes for people, and how the system can work effectively together to plan for and respond to compound pressures including infections with pandemic potential
- how to implement effective interventions to prevent avoidable admissions among vulnerable people (for example, warm homes, cool spaces, vaccination, hospital at home)
- how to implement effective preventive and treatment interventions for illnesses that cause excess burden in winter (such as influenza), during extreme heat and infections with pandemic potential
- how to implement interventions which enable routine health services to continue during times of increased pressure (for example, modern, minimally invasive procedures, online booking systems, care at home)
- how to implement interventions that can reduce hospital stay, promote smart discharge and reduce staff burden


Compound pressures on the health and care system include additional health care needs in winter, during extreme heat events and during epidemics or pandemics. These interact with other pressures including increases in the cost of living, disease levels post-COVID and the operational pressures that the NHS and social care face. The UK’s ageing population and NHS workforce pressures mean that demand will continue to increase.

On average over 32,000 excess deaths occur every winter in England and Wales with approximately 40% of excess winter deaths attributable to cardiovascular diseases and around 33% to respiratory diseases, including respiratory syncytial virus and influenza which peak in winter. Excess heat events are projected to increase with climate change, with negative health impacts particularly for elderly and vulnerable people, while the health, social and economic impacts of the COVID-19 pandemic were huge.

Research is needed to identify those most at risk and to develop and evaluate interventions to prevent them from becoming unwell and intervening early if they do. For example, 26% of acute hospital admissions would be potentially avoidable if medical interventions were provided prior to admission (PDF, 344KB). Research is also needed on how best all parts of the health and care system can better prepare for and respond to these pressures, including pandemic preparedness. This research could improve public and patient outcomes, reduce costs to the NHS and social care, improve services and support economic growth.

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This question was published as part of the set of ARIs in this document:

DHS Cs areas of research interest GOV UK


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