Over recent years, The King’s Fund has produced numerous reports examining community health services. We have found out about the challenges they face: money is tight, staff numbers are falling, and they often don’t receive as much attention as other parts of the health system. Our research has also highlighted significant pressures in wider services in the community – including general practice, social care and public health.
Building on this work, our new report – Reimagining community services: making the most of our assets – takes a deeper dive into community services to understand the challenges they face and, perhaps more importantly, how they need to change to respond to these challenges.
While funding and workforce pressures in community health services are indisputable, the report highlights that much more could be done to capitalise on the resources available in communities, both within the NHS and beyond.
We found many examples of places where this is already happening. In the Encompass multispecialty community provider (MCP) in Kent, multi-professional community teams of GPs, community nurses, geriatricians, social care workers, pharmacists and mental health professionals support people at high risk of hospital admission. In Nottinghamshire, GPs and community matrons are working on older people’s acute hospital wards to support timely discharge. And in Sheffield, community nurses are supported to provide advanced palliative care through remote supervision by specialists at a local hospice.
We also found examples of community health services working with a much wider range of community resources – such as charities, community groups, schools, housing and fire services. Wigan has pioneered an ‘asset-based approach’, involving a range of initiatives that bring together local communities and services to tackle preventable causes of ill health. And in Hull, the fire and rescue service is working with the community trust and ambulance service to provide an acute falls service.
The examples above are only a tiny selection of hundreds we could have chosen from to illustrate the innovative work going on in communities across the country. They show that, taken together, there are a wide range of resources available in communities that can be used to promote health. But they also show that efforts to strengthen and reform community services are usually confined to innovative projects rather than system-wide changes.
So how can we move beyond these pockets of innovation to create a community-focused health and care system that is fit for the future? The scale of this challenge is evident in the failure to make significant progress despite more than four decades of policy aiming to strengthen and better co-ordinate services outside of hospitals. The lesson here is that much greater attention needs to be given to implementation of these policies.
Changes of the scale described in our report can be delivered, but they will take time, resources and sustained leadership to be realised. This will require national action to identify community services as a priority and provide the policy guidance and resources to translate plans into practice, combined with local efforts to redesign services and make use of all the assets in each local community. This should be a priority for sustainability and transformation partnerships and accountable care systems, and every area should identify leaders to take this work forward.