The 20th century saw an explosion in the effectiveness of medicine. Effective drugs became available and, with the advent of antibiotics which dramatically reduced deaths from infection, more and more surgery became possible. This increasingly pulled the focus of care from the home to the hospital. The often breath-taking quality and complexity of the care that is now provided by hospitals is an essential part of healthcare system and has contributed to today’s increased longevity. But it has come at a cost as healthcare, in the minds of the public and the media, has become almost entirely dominated by hospitals, beds, bricks and mortar and we have struggled to explain to people the virtues and benefits of services delivered to people in their own homes and communities. These services too have become increasingly sophisticated and many things that once needed a hospital with its inherent risks can now be safely delivered in other settings.

It has become normal to define this care by what it is not - Out Of Hospital or OOH – rather than what it is Out Of Home. Healthcare at home, in clinics, surgeries and pharmacies should be seen as the default and desirable place for most people’s healthcare with only intense need, high risk and specialist intervention requiring the unique abilities of a hospital. Hospitals can be risky places for the older people with complex chronic diseases with increased rates of infection and sometimes over-treatment. At last this is being recognised and the drive now is to reduce our dependency on beds.

Community health services lack the high public profile of other NHS services, and yet they often reach the deepest into our lives. They are provided by that most important of NHS resource - trained and skilled professional people. They are part of our neighbourhoods; they come into our homes, and are with us for the long term. We live longer now than ever before, but are more subject to frailty and long-term conditions as a result. Community health services partner with colleagues across the NHS and in social care, education, charities and local government to personalise care packages which support people to maintain their independence for as long as possible. For me they provided the support and continuity, care and compassion that helped me care and allowed my Mum to die where she wished - at home seeing the daffodils burst into bloom and the buds on the trees.

Community health services lack the high public profile of other NHS services, and yet they often reach the deepest into our lives

Their personal, community-based approach means they take many different forms, and are often organised to meet local patients’ and service users’ particular needs. Their underpinning philosophy is to help people live as independent and fulfilling a life as possible for as long as possible. Yet their role has never been well-defined or as widely recognised as other parts of the NHS. Partly, this is due to the various forms they take: working so closely with GP services, they are often assumed to be part of the surgery. They are also rarely in the spotlight, lacking the propensity to make headlines, impact elections or generate national controversy. They are the best of localism in our NHS.

Consequently, their potential to provide the sustainable core of the NHS and drive new models of care can be under-recognised. In effect they are usually described in the context of other services, rather than in their own.

To deliver better and new models of care it is essential that we unleash the community health sector’s potential. That needs a vision which:

• explicitly recognises and encourages its role and deals with the artificial division between primary and community services
• offers new currencies to describe, measure and fund their work
• uses a language to explain, promote, measure and expand it.

Self-sufficiency, self-awareness and self-care (with the right knowledge, technology and local backup) will have a massive impact on keeping people healthier and helping them live with manageable conditions. This is essential for the five-year forward vision yet we are lagging in delivery. This will need commitment, leadership, and an NHS freed to develop and move to new models of local, community-based, person-centred care and provide the services the can only be delivered in a hospital at the same time.

As part of our commitment to helping we are publishing Community health services – a way of life, a narrative, to support and drive the conversations and plans for new models of care and sustainable NHS services. We need to talk the language of community health so that we can benefit from its current and future potential.

A new language and context

Community services need to be described in their own language. The NHS must see its mission as being about people, not patients. People live with increasing health needs and frailty, but we too often see them as patients or carers for whom a health transaction is the necessary fix. Until the NHS is oriented around people and their needs, rather than episodes of care, it won’t be able to address challenges of quality or cost.

Currencies and timescales need to be fit for sustaining long-term relationships in neighbourhoods, and across health and social care. Integration should be an outcome benefit experienced by the person; not simply an organisational design principle or administrative convenience.

A community approach to commissioning, governance and regulation

Commissioners will need to offer consistency and a long and integrated view in their commissioning and tendering behaviour. NHS provider boards and commissioners will need to pioneer and use different forms of information to assure themselves that services provided in the home, away from a hospital site, are safe and provide service users with a positive experience of their care.

Regulators should seek to change their working models, to gain assurance that trusts providing community health services are well-led and that agreed standards of care are met in different ways to the traditional hospital setting they are used to. This will require a new, sensitive approach to evaluating patient and service user feedback. How regulation and inspection will processes change when the care setting is increasingly an individual’s private home?

Right workforce; right skills, recognition and rewards

Providing support to stay healthy (or live more comfortably with ill-health) needs additional and adapted roles and skills. Different skills are needed to work in homes and high streets. Healthcare professionals will increasingly work alongside other care, support and advice professionals, using new approaches to relationship-building and collaborative working.

Being locally responsive, neighbourhood-based and person-focused does not happen automatically. It requires skilled professionals; well-managed and -led organisations; and strong and meaningful relationships between agencies and committed commissioners. Community indicators that work for the NHS, but also are meaningful to its partners, will be a key element; as will core competencies of professionals and organisations.

We need to talk the language of community health so that we can benefit from its current and future potential

These days, more than ever before, the NHS is invited as a guest in the everyday lives of people, rather than just being there when things go wrong. Community healthcare services excel in providing this form of personalised service, closer to home. It may seem odd that we will are having to relearn an approach we were once good at, but this will become a way of life for all of us and our families, a core means to protect the quality and financial viability of NHS services – in short, a way of life for sustaining better, healthier, independent living for longer.