The pressures outlined in this report act as a barrier to scaling up the much-needed focus on care in the community, in addition to financial and operational pressures on the NHS as a whole. The result is that there has been mixed progress in building up care in the community at scale and therefore NHS service delivery is moving away from the direction of travel set out in the FYFV (it is now generally acknowledged that the NHS has not been able to deliver this strategy).
In fact, there is a real opportunity for community services to not only contribute to but take a leading role in the transformation and sustainability of future models of care given their ability to:
- act as system integrators as they offer a valuable interface with other parts of the health and care system, particularly with primary and social care, and work across organisational boundaries
- understand local populations, hard to reach groups and place-based working, meaning they are well placed to tackle health inequalities
- address population health as they work collaboratively with and within multiple other parts of the public sector, such as schools and care homes, so can help tackle the wider determinants of health (social, economic and environmental)
- promote public health through universal interventions and local relationships with other public sector organisations, given their spread across a geographic area, as well as encourage self-care and patient activation
- spread the learning from their work in vanguards testing new models of care, particularly from multispecialty community providers where community services have been working together with general practitioners, nurses, hospital specialists, mental health and social care services to deliver integrated care in the community
- identify, strengthen and bring together community assets to promote health and wellbeing (e.g. voluntary organisations, informal networks).
It is vital that national leaders address these barriers and ensure community services are at the heart of the future health and care system.
In order to achieve the robust community sector that the NHS needs, community service providers need the following solutions to be implemented at a national and local level:
- realism about demand increasing, recognising that this trend will continue as acute care capacity becomes more strained and the ambition to strengthen and expand community services is pursued
- adequate financial investment, which targets specific services that can demonstrate an impact on system pressures, and support to build up community services.
- greater priority placed on community services within STPs and ICSs, including the role of community services in driving transformational change
- a greater priority placed on community services at a national level and key initiatives to turn these priorities into reality, such as completing the Forward view for community services to support STPs in their ambition to redesign services
- national support and investment in the development of an evidence-based clinical effectiveness framework, rather than using acute hospital measures of performance
- action to address staff shortages in community services, such as focusing on the supply of community nurses in the new workforce strategy or funding for continuing professional development for community nurses
- support for community services to develop their links with the wider health and care sector, such as housing, and drive the prevention agenda
- develop contracting and payment systems that incentivise care in the community.
- support to ensure that NHS community providers and social enterprises remain a continuing public service, in the face of competition with the private sector
- the headspace, time and investment to focus on prevention, improve patient outcomes and move care into the community at scale
- prioritisation of tackling health inequalities in the upcoming long-term plan for the NHS, as committed to by the secretary of state for health and social care.
This report shows the vital role that community services can play in preventing ill health and improving population health and wellbeing, which is more important now than ever due to the growing ageing population and prevalence of chronic disease. But it also reveals how the potential contribution of community services is being held back due to a lack of funding, staff and national or local prioritisation. It is vital that national leaders address these barriers and ensure community services are at the heart of the future health and care system.