Addressing the community challenge

by Michael Dimov

21 August 2019

Three significant developments will drive the transformation of community services over the next few years

The NHS long-term plan sets out an ambitious programme to transform the NHS with a new service model focused more on prevention and support and delivering joined-up care at the right time in the optimal setting. This summer, the HFMA has invited a number of commentators to address some of the key issues, challenges and opportunities in the plan. This week the focus is on the role of community healthcare in supporting service changes outlined in the long-term plan.

Lord Carter’s review of May 2018 and the NHS long-term plan have set up an ambitious agenda for community health services. Under these plans, community services will be a core enabler for the transformational changes that will ensure sustainable delivery of high-quality care by the NHS.

The process of closer working alignment between NHS England and NHS Improvement has offered opportunities for raising the profile and strengthening the leadership of community health services at national level. There are three significant developments within NHS England and NHS Improvement that are likely to drive transformational change for community health services in the next three to five years. These are: the establishment of the community care programme in the Strategy and Innovation Directorate, including the Ageing well initiative; the setting up of a Community Health Improvement (CHI) programme in the Improvement Directorate; and the appointment of Matthew Winn as a national director for community care.

The Ageing well programme focuses on three main areas of work: urgent community response and reablement services; enhanced health in care homes; and anticipatory care, with the main initial  objective of delivering the two-hour/ two-day access target allowing improved discharge pathways; and reduced non-elective admissions for patients with frailty.

Community Health Improvement evolved from the sector development team, which delivered Lord Carter review into community health and mental health services. It has been primarily responsible for implementing the core recommendations of the report. These include extending the Model Hospital platform and developing Model Community Health Services, publishing guidelines on improving operating models for services delivered in community and extending Getting it right first time (GIRFT) into community care. 

The first 10 service line compartments for community health services were launched on the Model Hospital platform in July 2019, covering approximately two-thirds of total activity reported through the Community Services Data Set (CSDS). CSDS data allows the development of metrics describing caseloads and activity patterns. Additional staff data collection is currently underway with 50 providers of community health services and this will enable producing more than 70 productivity metrics by the autumn of 2019. CHI is working closely with the PLICS and Model Hospital programmes to align developments and ensure measurements complement each other, give providers opportunity for robust analysis and inform the identification of improvement areas.

The launch of the first community health compartments is an important step in ensuring robust and transparent benchmarking of community health services. But this is only the first step in developing truly comprehensive dashboards that demonstrate the value delivered by these services.

CHI is already working closely with NHS RightCare and GIRFT to start adding outcomes data from available national collections and aligning it to service lines and pathways of care. In the interim, providers of community health services are encouraged to engage with the Model Hospital and ensure they are satisfied with the quality and completeness of their own benchmarking data presented on the platform. 

A good start is to ensure trust representation at the Model Hospital Ambassador programme for community health services, which will be launched soon, as well as participation in the Model Community Health Services webinar planned for October. Watch that space.