A sense of community

by Ros Preen

21 March 2019

A better understanding is needed of the impact community services can have, but there are already examples of improvements for patients and the service as a whole

The NHS long term plan brings community services to the fore, recognising their importance in supporting people to maintain independence and manage conditions outside of an acute setting. However, understanding where community services can have the most impact, continues to be a challenge.

The HFMA’s Healthcare in the Community Special Interest Group has taken up the challenge of improving our understanding and a new report considers how services that were traditionally delivered in acute settings, can add value to the system and the patient by being delivered elsewhere. This report is the first in a series, with future publications exploring the role of community services in prevention and how the sector contributes to the integration of care.

Services delivered in the community are not just about holding an outpatient clinic at a local community hospital, or a district nurse visiting an elderly patient to change a dressing. Developments in technology and the increasing ability of staff to deal with more complex patients outside of hospital, mean that a wider range of care can be delivered in a community setting.

Simple surgical procedures such as endoscopy and cataracts can be performed in community hospitals, with ambulatory care and diagnostics becoming common place services in these establishments. Primary care can deliver an increasing range of treatments, for example optometrists working in community practice can assess and treat glaucoma and wet age-related macular degeneration (AMD).

But community services can go much further than just moving a procedure from one clinical setting to another. Many areas have set up hospital at home or virtual ward provision, enabling people to stay in their own homes but still receive the care that they need. This allows people to get on with their life, reducing disruption to families and enabling people to remain in work. It not only improves the patient’s quality of life, but provides a fulfilling career for community staff, who can develop new skills in areas that they may not have been able to access before. These services report low staff turnover and high job satisfaction, which has a positive effect of staff and patient wellbeing.

For some, accessing statutory services is intimidating and something to avoid. Community services can go to those who need them, providing advice and services in local spaces, away from traditional clinical environments. This allows people to get the support they need and prevents them from ending up as an emergency admission.

There is still work to do to fully understand the impact that community services can have. The case studies in this report demonstrate that patient experience can be improved, while helping to manage demand for acute services. Money can be saved, and staff retention can be improved. But we need to develop a much better understanding of the financial impact of moving services into the community for the whole system.

It is heartening that the value of community services is recognised in the NHS long term plan and the HFMA will continue to support members to invest in and develop this vital part of the health and care system.

If you are interested in getting involved with the Healthcare in the Community Special Interest Group, please contact emily.simmonds@hfma.org.uk