Community health services are core to the future sustainability of the NHS. These essential, but sometimes overlooked, parts of the health system supports people throughout their lives by providing a range of services, including district nursing, health visiting, podiatry, and speech and language therapy.
Community services are now treating a rapidly growing number of people, many with high levels of acuity and complexity. The latest national figures show that there were 8.6 million community care contacts in January 2024 – a 13% increase on the same month in 2023.
In recent years national policymakers have committed to providing more 'care close to home' – a strategic shift that community providers are central to delivering. But government prioritisation and investment has failed to match these ambitions. Funding growth for community health services has not kept pace with growth for the NHS as a whole, and research by the King's Fund shows that hospital trusts have seen 27% funding growth since 2016/17 compared to just 14% for community trusts.
The incoming government now has a real opportunity to realise this vision. Providing more care close to home will unlock a raft of benefits for the health and care system, and most importantly, for people receiving care.
So, what's needed from our new government to make care closer to home a reality?
Increase the proportion of demand met in community settings
Community health services play a central role in preventing illness and intervening early when illness does occur, but capacity has been severely limited by a lack of investment. The public health grant, which provides funding for children's health, sexual health and drug and alcohol services, has been cut by 28% on a real-terms per person basis since 2015/6. It is vital to reverse these cuts – they have hit deprived communities the hardest and the impact will be seen through this generation and those that follow.
Access to capital funding for community providers is another important piece of the puzzle. Community providers need the right infrastructure to provide efficient and innovative care, and to integrate further with key partners, especially those in primary care and social care. As an example, capital funding can support the development of digital infrastructure that enables data sharing across sectors, which can support joined-up working, reduce duplication and improve staff productivity. It will be important for the new government to recognise the need for and benefits of both capital and revenue investment in the community sector, and for it to work closely with integrated care boards to ensure sufficient funding flows through the whole system.
Grow and develop the community workforce
The NHS Long Term Workforce Plan's commitment to doubling the community workforce by 2036/37 is both welcome and desperately needed. Despite rising demand, the number of staff in the community sector has been falling; the number of district nurses fell by nearly 50% between 2009 and 2022. The incoming government now has the significant and important task of overseeing the implementation of the plan.
Community providers are already working to boost staff numbers, for instance by developing new blended and flexible roles, and rolling out initiatives to support staff wellbeing and satisfaction. In the latest NHS staff survey, staff from community trusts were the least likely to report that they 'often think about leaving' (25%).
However, barriers to recruitment and retention must be removed to ensure the sector has the right number and mix of staff to meet increasing and changing demand. Crucially, the new government must work to resolve a persistent issue around pay parity for staff working in community interest companies and voluntary and independent organisations providing NHS services. Year after year, frontline staff providing key NHS services are excluded from the agenda for change pay uplift. This is damaging to staff morale, recruitment and retention, and means that some providers are making difficult decisions about cutting back services to fund the pay award.
Finally, an equivalent Long Term Workforce Plan for social care is key to realising the ambitions outlined for the NHS: the two are inextricably linked. Nowhere is this more evident than in community health services, where staff work in hand in glove with social care colleagues to provide joined up care.
Improve national data on and understanding of community health services
While steps forward have been taken to improve national data and understanding of the community sector, there's still further to go. Robust national data for the whole of the NHS is central to making well-informed decisions about where investment must be targeted and prioritised to create a resilient system. If the vision of a system refocused towards prevention and early intervention is to become a reality, the first step is understanding activity, staffing and performance in every part of the system.
Care delivered by community health services is central to building the next generation NHS. Community providers, and their staff, will be instrumental in creating a meaningful shift towards delivering more care close to home. This won't require restructuring the system or reinventing the wheel. Mostly it will mean building on the impressive work being done by community providers and ensuring that this is underpinned by the right national funding, staffing and data.
This opinion piece was first published by Public Sector Focus.
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