The NHS must take concerted action towards widespread adoption and adaptation of community focused approaches to care. By Chris Ham and Anna Charles
Delivering more and better integrated care in the community is an ambition that stretches back over several decades, most recently reflected in the Five Year Forward View. But services in the community have not received the attention or resources they need to make a reality of these ambitions.
The current picture across much of the country is one of fragmented, poorly coordinated community health services that are not well integrated with wider services such as social care and hospital services. This can lead to confusion for people trying to access and navigate services, not to mention the frustration of having to repeat information or undergo multiple assessments.
Previous attempts to reform community services have resulted in continuous reorganisation and structural change. At best, these changes have failed to make the improvements envisaged and, at worst, they have exacerbated the very problems they were trying to solve.
Community services need to be closely connected to all parts of the health and care system
This fragmentation often results in overlap, wasting resources and the time of staff and patients alike. It may also result in gaps between services, which risk leaving people without the support they need.
Financial pressures are having a significant impact, and there are critical workforce shortages in key staff groups – for example among district nurses. Services are struggling to meet current needs, let alone adapting to take on the bigger role envisaged in the forward view.
A fundamental shift is needed if we are to achieve the vision of a community focused health and care system that is fit for the future. We and others have argued that the government must provide sufficient funding to stabilise and sustain these and other services. But simply doing more of the same is not enough.
In a new report on community services, published today, we argue that they need to be closely connected to all parts of the health and care system. They should sit at the heart of local systems of care, drawing together all of the assets in the community wherever they are to be found. As well as services commissioned and provided by the NHS, these assets include services commissioned and provided by local authorities, the voluntary and community sector, and communities themselves.
In carrying out our research, we have seen and heard many examples of places that are starting to make a reality of this vision.
Making it real
Across the multispecialty community provider, primary and acute care systems and primary care home vanguards, integrated community teams have been introduced to deliver coordinated and proactive care to people with complex needs.
In the Encompass MCP in Kent, five community hubs bring together teams of GPs, community nurses, social care workers, mental health professionals, pharmacists, health and social care coordinators and others to manage the care of people at high risk of hospital admission. Other initiatives include a database of voluntary and community services, a social prescribing service and drop-in dementia clinics.
Many areas are exploiting innovations in technology to provide more and better care in communities, for example in Sheffield, where community nurses can access remote support and supervision from specialists at a local hospice to provide advanced palliative care, enabling people to end their lives in their own homes.
We also found examples of local systems that are bringing together a wide range of assets in the community to meet local needs. The Wellbeing Erewash MCP, for example, has developed an online directory of local voluntary and community groups, community connector roles to help people navigate and connect with local resources, and a time bank where people can offer their time and skills in return for help and support from others.
Another example can be found in Hull, where the fire and rescue service is working with the community trust and ambulance service to provide an acute falls service.
These examples, and many more besides, highlight the great potential of services in the community – defined broadly – to enhance the health and wellbeing of local populations. At present, these types of initiatives are confined to innovative projects.
The NHS and its partners must now take concerted action to move beyond pockets of progress towards widespread adoption and adaptation of community-focused approaches to care, drawing on the assets available in communities in a more systematic and coordinated way.
National leaders must identify community services as a priority and provide the policy guidance and resources needed to translate plans into practice
At a local level, these changes require the development of alliances and partnerships, underpinned by a shared vision and purpose, and overseen by strong system leadership.
The most promising possibilities in the short term are through sustainability and transformation partnerships and accountable care systems, where partnerships are forming and plans are already being developed to strengthen community services. Every STP and ACS should identify leaders to take this work forward, and this must be underpinned by deep engagement of staff and communities.
National leaders must identify community services as a priority and provide the policy guidance and resources needed to translate plans into practice. Lessons must be learnt from the failure of previous efforts to transform community services to avoid repeating past mistakes. Much greater attention needs to be given to implementation of these policies and, crucially, the focus should be on improving services for patients and users rather than changing structures.
Exclusive: Call for 'forward view' for NHS community services
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A call to action on community services