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Community services: How they can transform care


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    Nigel Edwards

This paper looks at the changes needed to realise the full potential of community services for transforming care. The Transforming Community Services policy, launched in 2008, was mainly concerned with structural changes. While the emphasis on moving care closer to home has resulted in some reductions in length of hospital stay, it is now time to focus on the bigger issue of how services need to change to fundamentally transform care.

The paper is based on contributions from a working group of community providers convened by The King’s Fund, which was tasked with exploring how community services can help deliver the transformation in care that was promised by the 2008 policy.

Key findings

Comprehensive change is required in the nature of community services and how they relate to the rest of the health and care system. The key changes needed are as follows.

  • Simplify services and remove unnecessary complexity, creating larger multidisciplinary teams based around primary care and natural geographies and working in new ways with specialist services (community and hospital-based).

  • Community services need to offer a rapid and accessible response; significant numbers of patients occupying hospital beds could be cared for in other settings but only if suitable services are available and can be accessed easily.

  • New ways to contract and pay for these services are needed, which means changes in primary care and hospital contractual arrangements; it also means changes in the infrastructure and workforce, to focus on providing whole person care and support.

  • Community services need to be better at reaching out – to harness the power of the wider community to support people in their own homes, combat social isolation, and create healthier communities.

Policy implications

Running community services in their traditional silos is no longer appropriate. They need to be more closely connected to all other parts of the health and social care system if they are to be a driving force in improving the health of individuals and communities. They need to be much more closely involved in key decisions about patients at an earlier stage in their journey through the system.

The changes proposed in this paper require leadership and investment, and require organisations to find new ways to work together effectively. There is also a need for fundamental changes in how primary care and hospitals are configured and in how social care is commissioned.