Oceans apart, connected together. Insights series

Impact 2: Early Recognition Preserves Choice

Authors:

Zainab Almukhtar

Tara Marshall

Across the UK and Canada, health and care systems are facing a remarkably similar challenge: people are living longer, often with frailty, multiple long-term conditions and increasingly complex care needs.

When deterioration is identified late, what may have been manageable earlier can become a crisis, an ambulance call, an emergency department attendance or a hospital admission. The cost of recognising deterioration too late is about much more than the cost of a hospital bed.

For an older or vulnerable person, an emergency admission can mean separation from familiar surroundings, anxiety, deconditioning and potentially a loss of independence. For families, there can be uncertainty, travel, time away from work and caring responsibilities. For the wider health and care system, the consequences extend from ambulance and emergency department capacity through to inpatient care, discharge, rehabilitation and social care.

So perhaps the question we should be asking isn't simply how do we reduce hospital admissions?

It is:

How do we recognise deterioration early enough that people still have choices about what happens next?

The cost of waiting

In England, emergency and non-elective hospital care represents a significant use of NHS resources. Earlier NHS economic modelling used approximately £400 per day for an acute hospital bed occupied by a non-elective patient aged 70 or over, while the current NHS National Cost Collection provides a much more detailed picture of how costs accumulate across emergency, inpatient and critical-care pathways (DHSC, 2023; NHS England, 2026).

But financial cost tells only part of the story.

For somebody living with frailty, dementia, a learning disability or complex long-term conditions, an admission can fundamentally change what happens next. NHS England has highlighted the risks of deconditioning and loss of function associated with hospital stays, particularly for people living with frailty (NHS England, 2026).

This is why early recognition matters.

It creates an opportunity to intervene while more options remain available.

Oceans apart, but a familiar challenge

Across the Atlantic, Canada is experiencing many of the same pressures.

More than 16.1 million unscheduled emergency department visits were reported in Canada in 2024–25, with approximately 1.8 million resulting in hospital admission (CIHI, 2026).

The experience of people living in long-term care is particularly important. Canadian data show that around 8,500 long-term-care residents died following transfer to hospital in 2024–25, with 18% dying within one day of transfer (CIHI, 2026).

These figures do not tell us that those transfers were inappropriate. Hospital care is essential when a hospital is where somebody needs to be. But they do prompt an important question:

Could earlier recognition, earlier clinical support and earlier conversations sometimes preserve more choices about where and how somebody receives their care?

Recognising change before it becomes crisis

Soft signs, Early Warning Scores such as NEWS2, supported by telehealth, provide an opportunity to identify physiological change earlier and communicate that change consistently between care teams and clinicians.

But technology alone doesn't deliver the outcome.

It's the combination of early recognition, workforce capability, a shared clinical language and clear escalation pathways that turns information into action.

This can shift the conversation from:

“This person is very unwell — where do we send them?”

to:

“Something has changed — what can we do now?”

That difference can be incredibly important.

By turning those long sentences into numbers, These Hands Academy's Connected Care Programme across Leicester, Leicestershire and Rutland have seen what becomes possible when telehealth, NEWS2, workforce development and structured escalation are implemented together.

The programme has generated tens of thousands of clinical observations and demonstrated reductions in avoidable hospitalisation alongside significant economic value.

This experience is also explored in the Care England and These Hands Academy paper, Managing deterioration in care homes: integrating NEWS2, which considers how NEWS2 can provide a shared clinical language between social care and NHS services to support earlier recognition and validation of concerns (soft signs), clearer escalation and more proactive care (Care England and These Hands Academy, 2026).

The important lesson is that the value isn't simply in taking a set of observations or generating a NEWS2 score, but in understanding why and what led to that activity beforehand.

It is what happens next.

Earlier recognition may create time to involve primary or community care. It may enable treatment to begin within someone's usual place of residence. It may allow a family to participate in decisions sooner. And, when hospital care is required, it can support earlier, better-informed escalation rather than waiting until deterioration becomes a crisis.

There is also something here that is sometimes less measured than the traditional return-on-investment calculations: value and choice.

Choice.

The choice to remain at home when clinically appropriate.The choice to involve the right people earlier.The choice to discuss what matters to the individual.And, particularly towards the end of life, the opportunity for someone's preferences about where they wish to receive care to remain part of the conversation.

The UK and Canada may be oceans apart, but the direction of travel is remarkably similar: prevention rather than crisis, community rather than hospital wherever appropriate, and technology that enables rather than replaces human care.

The opportunity now is not simply to deploy more technology.

It is to understand how we implement early recognition into everyday practice and turn information into meaningful action.

At These Hands Academy, that implementation challenge sits at the heart of our work: helping health and care systems translate evidence, technology and workforce capability into sustainable practice and measurable impact.

Because ultimately:

Early recognition preserves time.

Time preserves options.

And options preserve choice.

References:

Canadian Institute for Health Information (CIHI) (2026) Aging with Dignity: Using Data to Strengthen Long-Term Care for Canadians. Ottawa: CIHI.

Canadian Institute for Health Information (CIHI) (2026) Emergency Department Wait Times in Canada: Insights from a Health System Perspective. Ottawa: CIHI.

Care England and These Hands Academy (2026) Managing deterioration in care homes: integrating NEWS2. Care England.

Department of Health and Social Care (2023) Social Care Impact Assessments. London: HM Government.

NHS England (2026) National Cost Collection for the NHS: 2024/25. London: NHS England.

NHS England (2026) Principle 3: Establish systems and processes for frail people. London: NHS England.

These Hands Academy (2026) Connected Care Programme Evaluation, pilot to scale: Leicester, Leicestershire and Rutland.