Managing quality in community health care services

Community health care services provide vital care out of hospital for millions of people. From children’s services to care for older people and end-of-life support, the community sector plays a key part in meeting the challenges facing our health and care system. This report presents findings from a small-scale study into how quality is managed in community services. It explores how community care providers define and measure quality and recommends important next steps to support better measurement and management of quality.

Key findings

• Community health care providers are working hard to focus on quality, with examples of some robust quality governance systems and innovative ways to support quality improvement
• Community health care providers do have quality measurement systems but there are very few robustly comparable national indicators. This produces a dangerous blind spot in our knowledge of the overall quality in community services at a national level.
• Poor availability of information was a recurrent theme from respondents in our study, including historic under-development of data on quality and quality measures, lack of specific measures for community services, and lack of technology and data systems to support quality measurement.
• There is a particular shortage of information on quality among non-NHS providers – of especial concern in the community sector, given the high proportion of non-NHS providers.
• Many respondents listed staff shortages and caseload sizes as risks to the delivery of quality care. Financial and demand capacity pressures were also seen as risks to quality both now and in the future.

Policy implications

• National bodies (Department of Health, Trust Development Agency, Care Quality Commission, Monitor, NHS England) must act to develop and implement a clear road map for radically improving quality measurement in community services.
• The Community Information Data Set (CIDS) – comprising patient-level records of use of community services – must be developed urgently so that providers can use it to manage their services and commissioners can use it to underpin commissioning of community services
• Developing measures for quality in community services is vital, particularly as the needs of people using these services become more complex.
• Community health care providers must prioritise engaging staff in quality, supporting them with the skills and tools to improve quality.