We should aim for community-based care being the first option for NHS care, and aspirant community foundation trusts are crucial to achieving it, says Rob Webster

In the 22 years I have been involved in healthcare, I have seen many branches of the health and care system declare themselves the “Cinderella service” of the NHS. Mental health, geriatrics, diagnostics – all have claimed at some point that they are under-resourced, undervalued or both.

mental health depressed middle-age woman looking out of window

The same could be said for community services. They are central to delivering the aspirations of the NHS mandate published last year, yet barely get a mention.

‘We exemplify the cradle to grave, patient-centred service the NHS prides itself on delivering’

But while Cinderella might wait around for her fairy godmother, aspirant community foundation trusts are instead rolling up their sleeves, marshalling their scarce resources and drawing on all their own talents and abilities as they face the future.

There are 17 aspirant community foundation trusts – specialist providers of everything from newborn health visiting to end of life care and everything in between. We work with patients in their own homes and schools, on the streets, in health centres, prisons, community hospitals and even in shopping centres, right in the heart of people’s communities.

We exemplify the cradle to grave, patient-centred service the NHS prides itself on delivering and we do it well. In my own trust in Leeds, patient satisfaction consistently scores around 95 per cent. We know because we record it continuously.

Making an exception

When the Transforming Community Services programme published guidance on organisational forms, it made it clear that standalone foundation trust status for community service organisations was the exception rather than the rule.

The 17 organisations that have come together in the Aspirant Community Foundation Trust (ACFT) Network are that exception. We have already demonstrated our ability to consistently achieve high standards and meet rigorous controls in order to be established as standalone trusts. Those of us currently in the foundation trust pipeline have met all criteria to date.

We have expertise and knowledge – in our day-to-day work and as teaching and research organisations. It’s time for the rest of the NHS to open up and learn from our expertise.

‘More cost-effective models to meet patients’ needs can exist in the community rather than hospitals’

The challenges of modern healthcare need a new approach. Across the whole NHS we should be investing more resources in primary healthcare and in services delivered in the community, and moving away from our dependence on hospital-based care. What we really ought to be aiming for is community-based care being the first option for NHS care, rather than “just” the place for patients discharged for ongoing care.

No, we can’t “cure” someone of ageing, dementia, learning disabilities or chronic obstructive pulmonary disease, but we can work with them to provide services and support to live their life as fully as they wish to. A mandate for the NHS where what happens to you outside hospital has parity.

Breaking down barriers

The wider health economy can benefit not only by relinquishing its desire to “fix” every patient, but also by accepting that more cost-effective models to meet patients’ needs can exist in the community rather than in hospitals.

In Hammersmith and Fulham, a community-based respiratory team for patients with COPD saves the local health economy more than £170,000 annually in reduced first and follow-up outpatient appointments. The service also reduced COPD hospital admissions by 19 per cent, and readmissions by 66 per cent: a win-win situation for patients and the health economy.

I know the evidence base needs to grow. Sir John Oldham’s work on self-care, risk stratification and integrated health and social care teams is beginning to develop compelling evidence on how changes at scale will drive successful systems in the future, with better outcomes for patients.

‘We know we need to demonstrate to the public and politicians that we are ready for success’

While the NHS must open itself to emerging evidence, we must also remove barriers that make it difficult to change the status quo: the current tariff, which drives resources away from communities – just 10 per cent of NHS funding goes on community-based services – and regulation that strangles integrated care and risk taking.

Community roots

Working across organisational boundaries, the very nature of an FT focused on community services means ACFTs are in prime position to lead the NHS on its journey towards more care and services provided outside hospitals.

We are already firmly rooted in the communities we serve. By genuinely involving local people as we develop our applications for FT status, ACFTs have huge potential for success.

The top teams of the aspriring trusts are already involved in reshaping out-of-hospital care and are working with the NHS Confederation and other leaders to develop high-quality policy on community tariffs, community indicators and benchmarking.

We know we need to demonstrate to the public and politicians that we are ready for success. What we also need is our peers in the NHS to let us help meet the challenges ahead as equal partners. It’s what patients and the public need in the 21st century.

Rob Webster is chief executive at Leeds Community Healthcare Trust.