The purpose of this research was to understand the current state of community services and to explore how the health and care system needs to change to enable these services to meet the needs of the population now and in the future.
Growing financial and workforce pressures are having an impact on the ability of community 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. Community services are often fragmented and poorly co-ordinated, and are frequently not well integrated with other services in the community. This results in duplication as well as gaps between teams delivering care.
There is a great deal of innovative work going on across the NHS and beyond to improve community-based care. This is mainly happening through innovative projects rather than system-wide transformations in care delivery. A radical transformation of community services is needed, making use of all the assets in each local community wherever these are to be found, breaking down silos between services and reducing fragmentation in service delivery.
The most promising possibilities in the short term are through sustainability and transformation partnerships (STPs) and accountable care systems (ACSs), where plans have already been developed to strengthen community services and improve population health. More work is needed to ensure that all STPs offer a credible basis for improving care for their populations and strengthening services in the community, drawing on the design principles set out in this report
This summary highlights outcomes from implementation of an integrated care service, a single point of access for service users with long term conditions. It demonstrates how key recommendations from NICE’s guideline for intermediate care (NG74) can be delivered in practice.
NHS Improvement has written to the chief executives of all trusts providing community services setting out actions they must implement to reduce delayed transfers of care over winter. | NHS Improvement | HSJ
NHS Improvement chief executive Jim Mackey has said trusts must help improve delayed discharges over winter and listed six actions they need to carry out in the next six months:
Facilitate the sharing of patient data with acute and social care partners and from 7 November ensure daily situation reports are completed “to enable better understanding of community services at a national level”.
Jointly assess discharge pathways with local partners including “being an active participant in the local acute provider’s discharge and hosting operational discussions daily where necessary to discharge patients in community settings”.
Develop “discharges hubs” over the next six months and beyond, designed to be a single point of access for patients moving between acute and community services.
Ensure a “robust patient choice policy” is implemented.
Clarify to partner organisations what services the trust offers to patients.
Ensure collection of patient flow data and data on plans to improve patient flow.
Full detail is given by NHS Improvement who have produced the following report to help improve flow into and out of community health services:
This report gathers a wide range of insights taken from three community sites on how to implement a people powered approach to health and wellbeing.
These three main insights were found to be the most important to making a difference on the ground:
Helping people help themselves
Creating opportunities for people to help one another
Creating value between the professional and social spheres – helping health and care
Mobilising Communities was a short, experimental programme aimed at exploring the practical applications of the idea of ‘social movements’ in health in three communities in England.
The objective of the programme was to work with three sites to explore the opportunities to support effective ways of combining people power and community resources, together with publicly funded services, for better health outcomes across local communities.
The report goes into detail on how each of the three insights above can be developed to support a social movement in health for people and communities.
Self-care everybody’s talking about it
A discussion paper by Self Help UK on behalf of Regional Voices
This paper highlights the need to support patients to better manage their own health and the need for greater recognition of the potential for voluntary and community services contribution towards this. The discussion paper outlines the benefits of promoting self-care approaches and the briefing for the voluntary and community sector contains case studies.
The Social Care Institute for Excellence has published Creating the five year forward view for social care: how transformed and integrated health and care could improve outcomes and cost-effectiveness.
This updated paper explores the potential for scaling up the most promising examples of care, support and community health services, initially using data from Birmingham City Council, modelling their outcomes and costs. Originally published in November 2016, it has been updated to include additional models.
Chris Gregory, head of clinical systems for LGSS Local Health and Care Shared Service explains how mobile solutions are transforming the work of community-based health teams | NHE
As the IT provider to Northamptonshire Healthcare NHS FT, LGSS has been involved in delivering mobile working solutions to a number of community-based health teams, including health visitors and district nurses, and for providing similar solutions in local government.
The trend towards delivering care closer to home to meet both patient aspirations, and the need to deliver savings through the reduction of estate, means that increasing levels of flexible working are being demanded across the NHS. If done successfully, mobile working can help to deliver the type of service that patients tell us they would like from their health service.
As with many IT services we’ve had a few attempts at delivering practical mobile working solutions, each based on and constrained by the technology available at the time. Prior to our latest deployment, we asked staff what they needed from a mobile device. Overwhelmingly, those who responded wanted:
A small form factor: There is plenty of other equipment a district nurse needs to carry so devices need to be small, as light as possible and certainly no more awkward to carry than the files of paper notes previously used
Sufficient battery life to get through an entire working day
A fast start-up: Ensuring that as little of the precious contact time with the patient was spent waiting for the technology
Versatility: Multiple means of inputting data, suggesting the need for both touchscreen and keyboard input