NHS must not waste opportunity to improve care for most vulnerable says The King's Fund

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The NHS must learn from previous reorganisations and not waste the opportunity to modernise community services provided by district nurses, health visitors, physiotherapists and other staff.

That is one of the key findings from a report, Shaping PCT provider services: The future for community health published today by The King's Fund, which offers practical advice to primary care trusts (PCTs) on how to reform community health services. By October PCTs have been told by the government that they must separate their role as commissioners from their role as providers. The aim is to enable PCTs to improve community services by allowing them to focus on commissioning, removing the conflict of being both a provider and commissioner, and by encouraging competition for services.

The King’s Fund report agrees that PCTs need to concentrate on commissioning, but warns that simply making structural changes will not tackle the fundamental problems of poor productivity and lack of co-ordination with primary care and the care delivered in hospitals. It also notes that no one model for community services will work everywhere. 

The King’s Fund Chief Executive, Niall Dickson, said:

'Community health services have long been neglected. While there are examples of fantastic care, overall they have suffered from a lack of attention and the quality of support patients receive throughout the country varies widely.

'Yet looking forward what we expect from them has never been greater. We need to shift care from hospitals closer to people’s homes, and these services need to be at the heart of this. Together with general practice and effective social care they must transform the way we support patients with long-term conditions, arguably the greatest challenge facing the health service in the 21st century.'
The report advises that PCTs learn from the mistakes of previous reorganisations of community and mental health services and recommends the following.

  • Developing new structures for community health services will not in itself deliver benefits to patients. Whatever organisational models are chosen there will be a need for strong leadership, a commitment to reform the way services are delivered and a focus on designing services around the needs of patients.
  • Any new structure will require new ways of working in order to deliver more effective and integrated care.
  • Roles and responsibilities need to be clearly defined within and between different community health teams and managers have to ensure that changes, and the principles that underpin them, are properly explained to all their staff.

Report author Candace Imison, deputy director of policy at The King’s Fund, added:

‘This is a huge opportunity to transform the community health services, which are relied on by people with long-term and disabling conditions. But we should not underestimate the scale of what is required and the importance of new ways of working. PCTs should not force administrative change at a pace that will undermine more fundamental reform of ways of working. This process has the potential to make good the years of neglect in community health services and create a system that can meet the growing demands it faces.’

Read the full report: Shaping PCT provider services: The future for community health

Notes to editors

  1. For further information or interviews, please contact The King’s Fund press and public affairs office on 020 7307 2585, 020 7307 2632 or 020 7307 2581. An ISDN line is available for interviews on 020 7637 0185.
  2. The NHS Next Stage Review highlighted the need for modernisation within community health services. It recommended ‘… removing what are still unwarranted variations of care…’ and stated: ‘It is a central part of our strategy… that we support the NHS and community clinicians in transforming these services and according them equal status to other NHS services.’
  3. The King’s Fund is a charity that seeks to understand how the health system in England can be improved. Using that insight, we help to shape policy, transform services and bring about behaviour change. Our work includes research, analysis, leadership development and service improvement. We also offer a wide range of resources to help everyone working in health to share knowledge, learning and ideas.