Community services are strikingly undervalued and misunderstood. Too often they are missing from the national policy agenda, which can risk them being deprioritised at a local level. When they do receive national attention, the rhetoric around moving care into the community has historically fallen short of being made a reality. What’s more, the debate often focuses too much on providing care closer to home rather than arguing that community services offer the best way to promote good health, prevent ill health and improve population health and wellbeing as they are already working to provide integrated, high-quality care to their local community.
There is a danger that we overlook the crucial role that community services play in the NHS both now and in the future.
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While A&E admissions and ambulance handovers occupy the media headlines, there is a danger that we overlook the crucial role that community services play in the NHS both now and in the future. Given that community services support people with long-term conditions and provide a wide range of services to people throughout their lifetime, disease and demographic changes mean that community services are only going to play a more important role in adapting the health and care system of the future, whatever it looks like.
The community services offer
Operational pressures do, however, provide a burning platform to discuss the community service offer. We know that over 50% of people in hospital beds do not need to be treated in this setting. Many community service providers are supporting people to get back home after hospital treatment, such as the Supported Discharge Service at Harrogate and District NHS Foundation Trust which aims to ensure people can go home or be treated in the community as soon as appropriate. Despite the positive impact community services like this have on the system, these services are being decommissioned at the exact time that they need to be expanded.
Despite the positive impact community services have on the system, these services are being decommissioned at the exact time that they need to be expanded.
But community services are about so much more than supporting patients to go home after receiving hospital care. And the national bodies need to be more concerned about people going in to hospital in the first place. The real driver behind strengthening services delivered in the community – be they physical or mental health services – lies in better health and care for individuals and populations. Public health and effective prevention, which includes a focus on tackling health inequalities, are at the heart of what community services are all about.
For example, Cambridgeshire Community Services NHS Trust has expanded its integrated contraception and sexual health services across the whole of the East of England, with a specific emphasis on meeting the needs of hard to reach communities. But this type of innovative community service offer remains siloed – insufficiently supported, valued and resourced by the national bodies.
Public health and effective prevention, which includes a focus on tackling health inequalities, are at the heart of what community services are all about.
There are massive untapped opportunities in all kinds of community services, such as the contacts health visitors have with all families in a wide geographic area. This potential should be recognised as a driving force behind system working. Our new report NHS Community Services: taking centre stage, identifies a range of solutions to ensure national rhetoric gains traction.
Thanks to a national focus, mental health services have been able to make some progress to improve the perception, understanding and experience of people who use them. The same push now needs to happen for community services.
Time for a new conversation
With the forthcoming long-term funding settlement for the NHS, a green paper on social care and a national health and care workforce strategy, now is the time to move beyond semantics and put some grit behind repeated promises to strengthen and expand services delivered in the community.
As health and care systems are now on the trajectory to taking responsibility for population health outcomes, this presents a real strategic opportunity for community services as they are ideally placed to understand local populations and provide services that are truly tailored to their needs. But they need support to do so.
Trusts need support, such as further development of the national dataset and targeted investment, to build the evidence base that will demonstrate the impact of community services.
Trusts need support, such as further development of the national dataset and targeted investment, to build the evidence base that will demonstrate the impact of community services. This needs to focus on better outcomes for patients, as well as productivity and cost efficiencies.
The strengths of services delivered in the community often lie in their role as system integrators, bringing together primary and social care with the acute and voluntary sectors to provide seamless care, and their asset-based neighbourhood models that embed people in local networks and therefore into the fabric of community life. No other part of the NHS works so closely with the wider public sector and has such a strong history of partnership working.
Community services are the glue that holds the different parts of the health and care system together. They now need the national bodies to provide the rest of the toolbox to strengthen their offer for us all.
This article was first published by the HSJ on 21 May 2018.