What community services do and why this matters
Community providers deliver a wide range of services that keep people well in the community throughout their lives, from health visiting and paediatric services, to urgent community response, virtual wards, and frailty services. The community sector is responsible for 13% of all daily NHS activity and represents a fifth of the NHS workforce.
As part of its mission to 'build an NHS fit for the future', the government has committed to bringing care closer to home by shifting resources to primary care and community services. This goes alongside moving away from a health system centred on late-stage intervention towards one that puts proactive, preventative care front and centre. What's more, investing in the community sector pays off: for every £1 spent on primary and community care, economic output (GVA) grows by up to £14.
But underinvestment is holding the NHS back. The recent report by Lord Darzi concluded that over the past decade the NHS has been starved of capital funding, with the capital budget often being raided to fund day-to-day spending; £4.2 billion was raided from capital budgets to cover in-year deficits between 2014-15 and 2018-19. The result has been estates that are not fit for purpose, a significant backlog maintenance bill of approximately £14 billion, outdated equipment and a lack of investment in digital transformation, all of which impact productivity.
The scale of the problem around capital funding has impacted all parts of the NHS. However, community providers, and particularly community interest companies (CICs), are often unable to access the funding that is available. To date, central funding pots have tended to focus on capital funding for hospitals. To redress this, the community sector needs greater access to national capital funding to ensure providers can deliver high-quality care in the most appropriate settings.
Our research
With the government developing its long-term plan for NHS reform and in advance of the multi-year Spending Review, this report provides timely analysis of the current challenges the sector faces regarding capital investment. It also outlines strategic priorities for integrated care systems (ICSs) and government. It has been developed through both survey engagement and interviews with a range of leaders in the community health services sector.
Forty-three leaders from trusts and CICs responded to the survey. Additionally, those who wished to be contacted were invited to qualitative interviews, which allowed for a further discussion of the issues raised by the survey.
Our questions to leaders focused on the condition of their organisations' facilities and digital systems; the impact these had on patient care and staff productivity; and the consequences for integrated working. In addition, we asked respondents to prioritise how they would use extra capital funding to improve their services, as well as what their key asks would be of both their system and central government.