A report by NHS Providers says promises to bring more patient care closer to home by prioritising NHS community services have fallen flat.

National strategies under successive governments have concluded that the NHS must do more to help people stay well in their own homes and communities, avoiding the need for hospital treatment, if the health service is going to be financially sustainable.

This commitment was set out most recently in the Five year forward view (FYFV), which envisaged a significantly expanded role for community services, such as community specialist nurses and physiotherapy.

Support on the ground has failed to match the rhetoric, leaving many providers marginalised, underfunded and short staffed.

The report NHS Community Services: taking centre stage presents striking examples of good practice where community service providers have successfully developed new ways of working, collaborating with other services to improve care for patients. 

But it concludes that in practice, support on the ground has failed to match the rhetoric, leaving many providers marginalised, underfunded and short staffed.

The report highlights findings from a survey of NHS trust leaders – including more than half of those providing community services – which show:

• More than half of community trusts (52%) said funding in their area had fallen in this financial year
• Nearly half (44%) said they were cutting costs
• About a third (30%) said they had cut staff
• More than four out of five of all provider trusts (82%) were worried or very worried that community health services would not receive the investment they need to deliver the ambitions of the Five Year Forward View.
• More than nine out of ten said on current trends the gap between funding and demand for community services will grow over the next 12 months
• Nearly two thirds (62%) were worried or very worried about community services being able to maintain adequate staffing in 12 months’ time
• More than nine out of ten said that community services receive less national level priority than other sectors.

The report sets out why the expansion of community services, so often talked about, has not materialised. It concludes that these services are not sufficiently understood or prioritised at national or local level. They are overstretched, underfunded and understaffed. And they are held back by burdensome competition and procurement rules. The lack of national-level data, quality measures and targets has also hindered progress.

More than half of community trusts (52%) said funding in their area had fallen in this financial year.

However, the report also points to the galvanising potential of NHS community services to help people stay well and transform the way care is delivered. It highlights examples of innovation and good practice which demonstrate the enormous value of NHS community services in keeping people well, living independently even with serious complex conditions, and easing pressures on other services.

The chief executive of Cambridgeshire Community Services NHS Trust, Matthew Winn, said:

"The pressures facing hospitals are tangible and widely reported, but the steep rise in demand, coupled with the complex needs of people living at home are largely ignored and hidden. This report shines a clear light on a sector that needs greater support and national leadership to help realise the ambitions of supporting more people to be cared for safely at home."

The chief executive of Sussex Community NHS Foundation Trust, Siobhan Melia, said:

We see the impact of funding and workforce pressures every day and there are particular challenges for staff working in the community.

"For a long time, community services have flown under the radar at a national level in the NHS. But locally they have been quietly delivering a huge amount for those that rely on their services and the wider communities they serve.

"We see the impact of funding and workforce pressures every day and there are particular challenges for staff working in the community. They need access to support and supervision, as well as training opportunities to ensure that they can continue to deal with the most complex of cases and keep people safe in their own homes.”

The report concludes that NHS community services are uniquely well placed to take a leading role in delivering more joined up patient care through sustainability and transformation partnerships (STPs) and integrated care systems (ICSs). It also says the forthcoming long term funding settlement presents an opportunity to invest in community health services so they can take their rightful place as the linchpin of a strengthened and modernised health and care system.

The chief executive of NHS Providers, Chris Hopson said:

"There is a real opportunity for NHS community services to take a leading role in the transformation of health and care services.

"They are in a unique position to act as integrators, working across boundaries and collaborating with other parts of the public sector to tackle health inequalities.

We need to see to see community services given greater priority at national level and within STPs and ICSs.

"They have played a central role in delivering new models of care, working with GPs, nurses, hospital specialists, mental health and social care services to deliver integrated care in the community.

"And yet – as our survey makes clear – all too often NHS community services are marginalised, underfunded and short staffed.

"It is patients who are paying the price for the failure to follow through on past commitments as the rest of the health and care system struggles to keep up with rising demand for treatment.

"We need to see to see community services given greater priority at national level and within STPs and ICSs.

"These services need adequate funding, and action to address staff shortages.

"It is vital that national leaders address the barriers we have identified to ensure that community services are at the heart of the future health and care system."

Responding to the report findings, Lord Carter of Coles, who is leading a review into productivity and efficiency in NHS community and mental health services,  said:

"The NHS Providers report presents an excellent analysis of the challenges facing community health services and the opportunities for them to play a greater role in the wider health system. They are important in meeting the aims of the Five Year Forward View to deliver high quality, patient-centred healthcare, and their role in doing so should be properly recognised."

About the report:

• This analysis is informed by a survey of NHS trust chairs and chief executives, seeking their views on the state of the community sector. We received responses from 71 trusts (more than a third of the total) including 51 that provide community services (more than half of NHS trusts providing community services).
• In defining NHS community services, we have excluded services provided by GPs or mental health teams, but included some local authority-commissioned services. The most common community services delivered by the trusts who took part in our survey include community nursing teams, community specialist nurses, community physiotherapy and community palliative care. Other services included prison healthcare, sexual health services and school nursing.
• This is the third report in our series “The State of the NHS Provider Sector”. The spring/summer editions examine conditions for a specific sector, while the autumn/winter reports provide a comprehensive overview encompassing hospitals, mental health, community and ambulance services.

Read the full report. 

Read an overview article by Chris Hopson. 

Georgia Butterworth writes for the HSJ and argues that we need to recognise and build on the massive untapped opportunities presented by strengthening community services.