Community services are being neglected, warns NHS Providers

There has long been drive - also enshrined in the NHS’ Five Year Forward View - to push care out of the hospital setting and into the community, not only to improve efficiencies and reduce costs, but also as part of a wider shift from the treatment of episodic illnesses to promoting health and wellbeing.

However, the desired expansion and strengthening of community services has not taken place, said the group’s chief executive Chris Hopson in the report, NHS Community Services: Taking Centre Stage.

NHS Providers has now identified a range of barriers that are preventing the potential of community-based care from being realised.

For one, there is insufficient understanding of these services at a national and local level, it says. Over nine in ten respondents to its survey of NHS trust chairs and chief executives said community services receive less national-level focus, priority and attention than other sectors do.

Also, community services are in need of additional investment after a long period of under-funding, partly down to current era of financial constraint, but also because of community sector-specific challenges "such as the use of block contracts and the squeeze on local authority funding."

In fact, over half of trusts providing community services reported that their funding for these services has been reduced in 2018/19, the report notes, highlighting the scale of the problem.

As with other parts of the health service, community services are also struggling to meet increases in demand, which is already outstripping capacity.

Going forward, nine in ten trusts taking part in NHS Providers’ survey believe the gap between funding and demand for community services will increase or substantially increase over the next 12 months.

About a third of community trusts said they had cut staff, while nearly two thirds said they were either worried or very worried about community services being able to maintain adequate staffing in 12 months’ time.

The report concludes that NHS community services are "uniquely well placed" to help deliver more joined up patient care through Sustainability and Transformation Partnerships (STPs) and Integrated Care Systems (ICSs), and that the forthcoming long term funding settlement "presents an opportunity to invest in community health services so they can take their rightful place as the linchpin of a strengthened and modernised health and care system".

"There is a real opportunity for NHS community services to take a leading role in the transformation of health and care services," Hopson said. "And yet – as our survey makes clear – all too often NHS community services are marginalised, underfunded and short staffed.

"It is patients who are paying the price for the failure to follow through on past commitments as the rest of the health and care system struggles to keep up with rising demand for treatment."

"It is vital that national leaders address the barriers we have identified to ensure that community services are at the heart of the future health and care system," he stressed.

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