We have a problem. The NHS is overstretched, underfunded, and short staffed. These pressures are growing. The results were there for all to see last winter. Staff run ragged, patients delayed, standards of care slipping. It’s the same story right across health and social care.
The good news is there is a plan to ease these pressures by providing more care closer to home, freeing up much-needed resources for the sickest patients. Even better, this plan draws together the right skills from different services so the care people receive is carefully coordinated and tailored to their needs. To use the current jargon, it’s "integrated".
And best of all, this plan focuses on helping us all to stay well, and live independently. Who would argue with that?
But here’s the catch. This is not a new plan. It’s been around in various guises, under different governments for many years – most recently in the Five Year Forward View which underpins a lot of NHS strategy today. And the plan is to support and strengthen NHS community services which currently employ around one-fifth of health service staff and account for 100 million patient contacts in England every year. These include community and district nurses, physios, speech and language therapists, school nurses, podiatrists, sexual health services and end-of-life care.
We have a problem. The NHS is overstretched, underfunded, and short staffed. These pressures are growing.Chief executive
How on earth did that slip under the radar?
In our new report NHS Community Services: Taking Centre Stage, we highlight examples of innovation and good practice which are transforming the way care is delivered, meeting the needs of local people, keeping them well, helping them live independently even with serious complex conditions, and easing pressures on other services. So it can be done.
But we also identify the barriers that have prevented schemes such as these from taking root across the country. The harsh reality is that these services are not sufficiently understood or prioritised at national or local level. In a survey of NHS trust leaders for our report more than 90% said that community services receive less national attention than other parts of the NHS.
And at local level fewer than 20% said community services were very influential in the current programme to modernise and integrate local health and care services. That is a real opportunity gone begging.
It follows that while these services continue to be marginalised, they will be underfunded. And so we see from our survey, more than half of community trusts reported that funding in their area had fallen this year. Nearly a third had reduced staff. And workforce concerns are a particular problem for community services. Since 2010 the community nursing workforce has contracted by 14%. District nurse numbers are down by 44%. And it’s clear from our survey the expectation is that workforce pressures will get worse still in the coming year.
More than half of community trusts reported that funding in their area had fallen this year. Nearly a third had reduced staff. And workforce concerns are a particular problem for community services.chief exeutive
All this, remember, at a time when demand for community services is going through the roof. This is not just about a growing and ageing population with more complex conditions. It is also because thanks to advances in care and treatment, it is now possible to look after people at home who, ten or twenty years ago, would have needed to stay in hospital. That is a success story. You only have to see the impact schemes such as the Hospital@Home service in Sussex to see the benefits for patients and staff, and financial savings for the NHS. It’s a win-win-win.
But more than 90% of trusts thought the gap between funding and demand for services will grow in the next twelve months. This is bad news for 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.
It affects people who have to wait longer – often lonely, anxious and in pain – for the care they need at home. It causes delays for patients who could be discharged from hospital if the right treatment or rehabilitation were available. It can impact on our ability to stay well, avoiding sickness and the need for treatment. And it can make the difference over whether we are able to die in the manner and place of our choosing.
More than 90 per cent of trusts thought the gap between funding and demand for services will grow in the next twelve months.chief executive
No one is suggesting this will be easy to fix. NHS community services come in a range of shapes and sizes, with different approaches in different places. This diversity can be a strength but the contract and tendering process is complex, burdensome and sometimes puts the NHS at a disadvantage. We need to seize the opportunities presented by the push for integrated care and the Prime Minister’s commitment to increase long term health and care funding to make good on past promises, and bring NHS community services centre stage.