The Kings Fund has produced an excellent research paper which focusses on the organisation and delivery of community services. A great deal has been written about the pressures facing busy A & E departments and hospital trusts; but the same pressures are also being felt within the NHS community services which are struggling to meet the demand to provide care for people within their own home.
There is no single model of community service provision – delivery is dependent upon local needs, demographics, historical provision and the availability of other, often voluntary, services locally. The patients receiving these services often have complex health needs, which results in a dependency upon a number and variety of health and social care professionals to meet these needs.
Community health services have not escaped the financial or workforce pressures within the NHS, and this is having an impact on their ability to meet current needs and delivery of the NHS five year forward view (Forward View). Often this results in families and carers having to fill the gaps in service provision.
The provision of a good community service is well understood, and the authors of this paper summarise the elements of such a service using 10 design principles – the application of which will vary according to funding, local need and local service provision.
10 Design Principles for a community service
- Organise and co-ordinate care around need – integration, co-operation and co-ordination with other parts of the health and social care system are vital to avoid gaps and duplication in service provision. Information sharing and IT system interoperability are needed to support this.
- Understand and respond to people’s physical health, mental health and social needs in the round. Adopt a holistic approach to ensure a person’s physical, mental and social needs are addressed together rather than separately.
- Make best use of all community assets to plan and deliver care to meet local needs. Identify and use the full range of statutory services, voluntary and community sector organisations, private sector services, support groups, social networks, community spaces/buildings etc.
- Enable professionals to work together across organisational and service boundaries. This can be achieved by fully integrated community teams or regular multidisciplinary meetings, communications, shared care plans etc with other services.
- Build in access to specialist advice and support. Community services manage highly complex patients, and therefore access to specialist input when necessary should be facilitated without the need to go through complex and indirect referral pathways.
- Focus on improving population health. Health care is just one factor in a population’s health and wellbeing – other factors include the environment, poverty, access to education, employment etc – all of which need collective management.
- Empower people to take control of their own health and care. Educate and encourage people to lead healthier lifestyles, and support self-management of their conditions wherever possible.
- Design delivery models to support and strengthen relational aspects of care. Continuity of care is highly valued by patients, carers, and families and should be supported by service delivery models.
- Involve families, carers and communities in planning and delivering care. Families, friends etc make a significant contribution to the care and support of patients within the community, and therefore they can provide valuable input into the planning of future models of community care, both in identifying local needs and gaps in service, and in the development and implementation of potential solutions. It is important the role of carers is supported.
- Make community care the central focus of the system. This will require a whole system focus shift from hospital-based care to community-based care as it will require the support of general practice, social care, hospital trusts etc to work differently.
Community services vary throughout the country and comprise a wide range of assets which should be fully exploited to meet the needs of the local population. This should include pooling health and social care budgets, with an integrated approach to commissioning and workforce development. Leaders need to be identified who can fully engage the wider health and social care system, as well as the community and private sector in taking this work forward. STPs and ACSs have already developed plans to strengthen community services and improve population health, and therefore offer a vehicle and an opportunity to take this work forward.
There is a need for local and national leaders to work together to publish a plan for the future of community services similar to the General Practice forward view, which sets out the future vision and details the resources necessary to achieve it. This should involve the alignment of regulation, commissioning and funding of health and social care.
However, this work will necessitate new, ring-fenced resources for investment in these services as hospitals cannot reduce their capacity whilst under intense pressure. Rather a gradual resource shift should take place as more services are delivered in the community reducing pressure on hospital beds.
Whilst the scale of transformation necessary is large, it can be achieved with good leadership, resources and time. (Mental health is a good example of how change on this scale can be delivered). The ultimate aim is to have a higher proportion of integrated care closer to home within the community which will improve the health of the population.
To read the full research paper from the Kings Fund please click here.