A vision for the future of community-based health services

Throughout the history of the NHS, a series of policies have sought to strengthen and co-ordinate services outside hospitals. The levers used to do this have often been structural and organisational, and community services have been subject to multiple reorganisations. But despite repeated attempts, ambitions to transform community services have not been realised. 

1948

Community health services are the responsibility of the public health arm of local authorities.

1962

The hospital plan emphasises the need to expand services in the community.

1963

Health and welfare highlights wide variation in local authority community services provision.

The Gillie report emphasises the importance of GPs being supported by a wider primary care team and the need for closer integration between GPs and other services.

1965

The report of the Seebohm Committee calls for better co-ordination between social care and other health and welfare services in the community. 

1974

Responsibility for community health services is transferred to the NHS to tackle poor co-ordination between community and hospital services. Area health authorities are created, and joint planning and consultative committees are formed with local authorities. 

1987

Promoting better health proposes the development of primary care teams, with GPs working alongside health visitors, community nurses and other professionals.

1988/89

The Griffiths report and Caring for people highlight fragmentation of community services and emphasise the need for collaboration between the NHS and local government. They set out proposals for local authorities to plan and manage social care, but not necessarily to be direct providers. This leads to significant growth in independent sector provision. 

1989

Following the publication of Working for patients, community services increasingly establish themselves as standalone NHS community trusts.

1997

The new NHS: modern, dependable describes the aim to deliver more integrated health and social care services in the community. Primary care trusts (PCTs) are established and most community health services are effectively merged into PCTs. 

2000

The NHS plan: a plan for investment, a plan for reform proposes redesigning primary and community services, creating 500 new ‘one-stop’ primary care centres, and investment in intermediate care. The option to form care trusts is introduced, but relatively few are set up. 

2006

Our health, our care, our say sets out a wide-reaching strategy to shift care out of hospitals and expand community provision, including by shifting resources. A variety of measures are introduced to promote integration, improve access and strengthen prevention. 

2008

High quality care for all: NHS next stage review recommends the separation of PCT commissioner and provider functions and PCTs are directed to consider a range of organisational models for community services.

NHS next stage review: our vision for primary and community care encourages greater pooling of resources by PCTs and local authorities, and the development of new tariffs to encourage more provision of health care in the community.

2009

Transforming community services: enabling new patterns of provision requires primary care trusts to come up with a strategy for community services and to identify future organisational models separating their commissioning and provider functions. 

2012

The Health and Social Care Act transfers responsibility for commissioning community health services from primary care trusts to newly formed CCGs. Some services – for example public health and health visiting – are transferred to local authorities.

2014

The NHS five year forward view sets out a vision of how NHS services need to change to meet the future needs of the population, arguing for greater emphasis on prevention, integration, and putting patients and communities in control of their health. It calls for a shift in investment from acute care to primary and community services, and outlines several ‘new care models’.

2015

NHS organisations are directed to come together with local partners to develop Sustainability and Transformation Plans (STPs), five-year plans for health and care services in their area.

2016

The 44 STPs are published. All include proposals to redesign primary care and community services and it is often expected that this will reduce demand for hospital care.