Care Closer to Home in Manchester

Manchester, like many health and care systems nationally, has been facing sustained pressure across its urgent and emergency care (UEC) pathway. Despite the dedication of staff, residents were not always receiving the most appropriate support or achieving the most independent outcomes.

In 2024, an assessment carried out by Newton found that many hospital admissions could have been safely managed in the community, and that almost a third of discharges were happening to non ideal settings, resulting in an avoidable dependency on long term care. Frontline teams also lacked timely access to data and visibility of community options, contributing to inconsistent decisions and variation in health and care outcomes. These challenges were compounded by fragmented system working, complex access routes into community services and a digital infrastructure that made staff decision making difficult.

With Manchester Foundation Trust placed in NHS England’s Tier 1 for challenging UEC performance, it became clear that the city needed a more unified and integrated approach; one that would shift care closer to home, strengthen community provision, and ensure people receive the right support in the most appropriate setting at the right time.

Manchester’s Care Closer to Home programme is helping the system make tangible progress toward its long‑term vision: a UEC system that keeps people well, prevents avoidable escalation, and supports residents to remain independent closer to home. By strengthening community services, improving access routes, and reshaping pathways that previously defaulted to hospital, the city is now delivering care in a way that better aligns with its strategic priorities of improving outcomes and promoting independence, whilst working as one to build a sustainable, person‑centred health and care system.

Frontline teams across Manchester are increasingly able to make treatment decisions that put independence first, supported by clearer processes, better data visibility, and stronger relationships between partners. As a result, residents are experiencing a more responsive system that intervenes earlier, reduces time spent in hospital, and ensures people return to their own homes as quickly as possible – if not immediately.

The programme has helped to cultivate a more collaborative culture across Manchester’s health and care system. Partners are now working with a clearer shared purpose, supported by improved visibility of performance and a stronger collective understanding of where change is needed. This has laid the foundations for a future UEC model that is more integrated and better aligned to what Manchester wants for its residents: care that is compassionate, community‑focused, and helps people live independently for longer. This is explicitly aligned to the NHS 10 year plan and the UK Government’s national ambition of shifting care ‘from acute to community’.

The Care Closer to Home programme is already delivering meaningful progress towards Manchester’s ambition for a more responsive, community led UEC system that keeps residents well and independent for longer. People are spending less time in hospital, front‑door pressures are easing, and more residents are returning home sooner with the right support. These changes are contributing to stronger performance on ambulance handovers and 4 and 12 hour waits, while also reducing unnecessary bed occupancy, helping Manchester Royal Infirmary to remove corridor care and close escalation wards.

Outside of the acute setting, the programme has also delivered significant reduction in Manchester City Council spend on both home based and bed based long term placements through avoiding unnecessary hospital admissions that cause deconditioning, appropriate pathway decision making on discharge from hospital, and increased use of reablement services to enable returns to more independent settings.

As of January 2026, after 12 months, the Care Closer to Home programme has resulted in:

• Reduction in bed demand by 130 beds, of which 94 beds have been closed and the ED queue for an admitted bed has been reduced by 25%
• 66% reduction in 30-60 minute ambulance handovers
• 98% reduction in 60+ minute ambulance handovers
• 14% improvement in 4 hour performance in December 2025 vs. 2024 baseline
• 9.2 hours reduction in the time spent waiting in the emergency department for admitted patients
• 35 fewer people per day waiting in hospital without a reason, meaning people are returning home more quickly
• 30% reduction in patients spending longer than 3 weeks in the MRI
• 10% reduction in average length of stay (including a 25% reduction in length of stay for patients returning home without ongoing social care)

The programme is also creating the headroom needed to reinvest in community services, supporting Manchester’s long term shift towards earlier, preventative care. Perhaps most importantly, the programme leaves behind a stronger, more unified system. Partners now share consistent decision making approaches, a single view of performance, and a more collaborative culture. These foundations give Manchester the capability and confidence to scale the model across more localities, continue shifting activity closer to home, and sustain the improvements already achieved.