A report from NHS community services providers suggests that their services are at the point of taking centre stage. For many years now, successive national NHS policies have stated that community services should play a more central role in the future health and care system than they do at present. The most recent iteration of this ambition was the Five year forward view (FYFV) (NHS England, October 2014), but this initiative was only the latest in a long line of NHS strategic plans that sought to strengthen the position of the community sector and deliver care closer to people’s homes.
This argument in favour of stronger, expanded community services has been made for three overarching reasons:
- The NHS must radically improve its ability to prevent illness and support people to ensure their own wellbeing if it is going to be financially sustainable. Strengthened community services are crucial to bringing the right focus on preventing ill health, improving the population’s health and wellbeing, and tackling health inequalities.
- The disease burden is shifting as people are living much longer with multiple long-term conditions that cannot be permanently cured by hospital intervention. Conditions such as diabetes and hypertension require a very different type of interaction with patients and the public than, for example, a traumatic injury. Community services offer the most appropriate way to promote good health and prevention and provide joined-up care for an ageing population.
- Acute inpatient services, in both hospitals and mental health services, are under huge pressure and they are currently being used unnecessarily and inappropriately for patients who could and should be treated closer to home. It is better for patient care, better for performance outcomes, and better for the NHS budget to treat as many patients as close to home as possible, with community services once again at the heart of provision.
However, while the burning platform for this shift in the provision of care is the financial and operational pressures in the acute sector, the real driver for community services lies in good population health and prevention at scale. Too much time has been spent making the case for community services in relation to “moving care closer to home”, when it is the combination of all three reasons that makes the case. Concentrating solely on this defines community services in relation to what they are not, rather than what they are. This then colours the debate around community services, which continues to be acute-focused and about shifting services between settings rather than acknowledging the positive reasons for strengthening community services.
The analysis for this report is informed by an online survey of NHS trust chairs and chief executives representing 51 trusts that provided community services and 20 that did not. The contribution of these 51 trusts. This means over half of all trusts that we are currently providing a substantial amount of community services.
To complement the survey a number of interviews were carried out to gain a richer understanding of the issues facing community providers.
Despite the potential of community services, the survey and analysis found seven reasons why ambitions for the community sector have not yet been realised. And, in doing so, the report provides a clear manifesto for what needs to change if community services are going to take up a more important role: The seven reasons are:
- There is insufficient understanding of community services and the community provider sector among the national bodies, the Department of Health and Social Care, commissioners, politicians, patients and the public.
- Community services have been, and continue to be, an inconsistent national and local priority.
- There needs to be greater financial investment in community services.
- Demand for community services is outstripping capacity and supply.
- Structural inequity means that competition and procurement disproportionately affect community service providers.
- There are worrying staff shortages in key roles.
- There is a lack of national-level data and a national focus on an improvement approach for community services.
The report from NHS community services providers puts clearly the overarching reasons for more investment in community services. However, change is unlikely to come about unless there is a major shift in the policy of NHS to recognise the value and contribution of community services, who will then move more closer towards centre stage
Albert Cook BA, MA & Fellow Charted Quality Institute
Bettal Quality Consultancy