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Community services policy has ‘failed’ – King’s Fund

The King’s Fund has issued a radical seven-step plan for changes to community services, arguing that policy up to now has “failed” to achieve the longstanding ambition of moving care out of hospitals and closer to people’s homes.

The recommendations in the report, commissioned by the NHS Confederation Community Trusts group and based on a literature review, two workshops and a study network, are based on closer working with groups of GP surgeries and multi-disciplinary teams

The King’s Fund says implementing the recommendations would cut hospital admission rates, releasing resources for patients to be cared for at home and stemming growing demand for beds.

Nigel Edwards, senior fellow at The King’s Fund, said: “There is an emerging consensus about the value of community services. Although some progress has been made, radical change is needed to realise the ambition of moving more care out of hospital and closer to people’s homes. With the health system under increasing pressure, especially the hospital sector, improving the effectiveness of community services is essential – it is time to bring community services from the margins to the mainstream.”

These are the seven action points in ‘Community services: How they can transform care’:

• Reduce unnecessary complexity of community services

• Forge much closer relationships with groups of general practices

• Build multidisciplinary teams for people with complex needs, including social care,

mental health and other services

• Support these teams with specialist medical input – particularly for older people and those with chronic conditions

• Create services that offer an alternative to hospital stay

• Build the information infrastructure, workforce, and ways of working and commissioning that are required to support this

• Reach out into the wider community to improve prevention, provide support for isolated people, and create healthy communities.

Too often, the report argues, the health debate focuses on primary and secondary care alone, missing the key role community services play. Its new report aims to change this.

Discussing the policy implications of the plan, the King’s Fund said: “Running community services in their traditional silos is no longer appropriate. They need to be more closely connected to all other parts of the health and social care system if they are to be a driving force in improving the health of individuals and communities. They need to be much more closely involved in key decisions about patients at an earlier stage in their journey through the system.

“The changes proposed in this paper require leadership and investment, and require organisations to find new ways to work together effectively. There is also a need for fundamental changes in how primary care and hospitals are configured and in how social care is commissioned.”

Welcoming the report, chair of the NHS Confederation's Community Health Services Forum (CHSF), Michael Scott, said: “At the coal face in the health and care sector, the unique expertise of community services and the crucial role they play have long been acknowledged and valued. What's way overdue is getting this recognised more widely. It's time for the rhetoric on community services to become reality, and to support this shift through reforms to the NHS payment systems.

“This isn't about community-based services or hospital-based care. It's not a choice between one or the other. It's about all parts of the health and care service playing their best role, joining up with each other, around patients. The health service is an ensemble performance, not a solo.”

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