Supporting community providers to manage and improve quality

If you look at how the NHS is represented in the media, health care dramas tends to equal hospital dramas: ‘Casualty’, ‘Holby City’, even the marvellous ‘Getting on’. Community services often feature as slightly misty-eyed nostalgia of district nurses and midwives on bicycles – a bit of a blast from the past.

Hospitals can sometimes be busy, confusing places, to be avoided unless absolutely necessary, especially by people who are already vulnerable, frightened or confused. Care provided closer to (or in) people’s own homes is often preferable in many circumstances.

Today’s mantra is that co-ordinated care is better for people using health services, and will be better for the public purse too. Though no-one would argue with the former, the jury is still out on the latter. Community services are a vital part of delivering co-ordinated care, and could be the answer to many of the health service’s woes in the future.

That’s why it is so surprising that community services feature so little in the public dialogue on health care quality. Targets in acute services are widely known: cancer waiting times, four-hour waits in A&E, 18-week referral-to-treatment times. Where are the equivalents in community services? And what do we know about the quality of community services, given their importance in riding the wave of increasing demand and tighter purse strings?

In our new report, Managing quality in community health care services, we explore this further. We found that, in a number of ways, our hopes for community services are justified: there are numerous examples of innovation and creativity in the way in which providers are looking at quality. But linking back to my earlier blog on the challenges of using data to understand quality we also found cause for concern. Community providers told us that they lacked robust, comparable indicators to help them judge and compare the quality of care. National datasets for community services are distinctly limited in what they can say about the care delivered in the community and in people’s homes.

When you consider that quality failures in the acute sector can slip by under the radar despite the plethora of measures, systems and metrics, and the very public manner of care provided in hospital wards, the lack of information on quality in community services is a worrying blind spot.

While community services have not lacked policy attention in terms of successive structural reorganisations, they have missed out on support for quality management. The health care system is not doing its best to support community services in their quality improvement efforts, which are essential if they are to play their part in the future vision of care and support outside the walls of the hospital. At worst, there is a serious risk that poor or declining quality in the community could be missed.

It’s time that the health care system harnessed the creativity and innovation that exists in community health services, to support it to manage quality better.

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Comments

#362769 Geraldine Child
Direct Voice manager
Agewell CIC

Agewell works with older people on health promotion, including falls prevention. We have found problems with the availability and sustainability of community physiotherapy. There appears to be a short term, intensive service model which sometimes does not suit older people who have co-morbidities.
Services appear to be mainly interested in throughput of patients.

#446828 Dinesh Perera
Clinical Audit

''At worst, there is a serious risk that poor or declining quality in the community could be missed''. That sums up my experience of community mental health nursing. There's many factors at play;
Under funding-impact staffing levels(high ratio of case worker to client), this unmistakably impact the quality of care. In the case of mental health often infrequent contact, follow-up means people slip through the net & present a risk to them or others. Poor quality of care in the community, whether mental health or not leads to crisis intervention & unplanned emergencies which adds to the strain on in-patient services eventualy, which is what community care is supposed to avoid, in the first instance! what a paradox.

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