Reimagining community services: Making the most of our assets
This report is a call to action on community services. The longstanding ambition to strengthen these services has not been realised. Growing financial and workforce
pressures are having an impact on the ability of service providers to meet the needs of the population and to make a reality of the vision set out in the NHS five year forward view (Forward View) (NHS England et al 2014).
We argue that a radical transformation of community services is needed. This means increasing the share of the NHS budget allocated to these services and making use of all the assets in each local community wherever these are to be found. It also means breaking down silos between services and reducing fragmentation in service delivery. The focus must be on improving population health as well as integrating care.
This report differs from some previous analyses of community services by adopting a broad definition of their scope. We include services commissioned by the NHS and local authorities as well as related services delivered by the third sector, the private sector, carers and families. Taken together, these services comprise a wide range of assets and there are many opportunities to use them more effectively to meet the population’s needs.
Every area of England should exploit these opportunities, recognising the time it will take to increase the share of the NHS budget allocated to community services. This should include pooling health and social care budgets, redoubling efforts to integrate services, and fully engaging the third sector, the private sector and others in transforming care. NHS primary care and community health services should be at the centre of these efforts.
There are examples everywhere of work to bring community services in from the cold, for example in the new care models set up to implement the Forward View and the primary care home pilots. The challenge facing the NHS and its partners is to move beyond these pockets of innovation and to make community-based care the central focus of the health and care system. The direction has been set by the Forward View and a credible implementation plan – similar to those for general practice and mental health – must be developed to achieve system-wide impact. The elements of what community services should look like are well understood and we summarise these elements in 10 design principles set out in this report. How they are applied will vary from place to place depending on the population’s needs and how services are currently organised and funded. Each area should identify leaders to take forward this work and should engage staff and communities in the work that needs to be done.
Every area should also revisit its sustainability and transformation plan (STP) to ensure that plans are credible and will bring about improvements in care. This means recognising that it is not realistic to release resources from acute hospitals to invest in services in the community when hospitals are working under intense pressure. It also means identifying the funding and staffing needed to make a reality of new models of care and creating time and support for this to happen.
Early evaluations of the new care models show that strengthening services in the community may moderate, and in some cases reduce, demand for hospital care.
The care models are examples of a future in which primary care teams, integrated community teams and others work together to meet the needs of patients and service users. These care models have benefited from additional funding and the ability to release staff to work on service improvement.
Changes to mental health services since the 1970s indicate that changes on the scale of those described in this report can be delivered but they will take time, resources and sustained leadership to be realised. The goal should be to bridge the gulf between the rhetoric and the reality of care in the community by delivering
a higher proportion of care at home or closer to home, reducing fragmentation in service delivery and improving overall population health. The government and national NHS bodies must give the same attention to community services as they have given to acute hospital services over a long period of time.