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King’s Fund calls for improved scrutiny of community health services

Community healthcare providers need a similar level of scrutiny to that of hospitals, and the Department of Health and other national bodies need to develop a road map for improving quality measurement in community services, according to a new report from the King’s Fund.

The fund’s report Managing quality in community health care services looked at community based services such as community nursing, end of life care, health visiting, physiotherapy, occupational therapy, speech therapy, podiatry and sexual health services. These services account for around £10bn of the NHS budget.

According to the report the community sector is “crucially important to achieving the transformation in services that we need to meet the current and future challenges facing our health care system”.

But it found that service providers were severely hampered by the absence of national indicators to help measure their performance.

This meant there was a lack of data for the services that are provided, with service quality and patient outcomes, “largely unknown at national level”.

It added that there is a particular shortage of information on quality among non-NHS providers, which is especially concerning due to the high proportion of non-NHS providers in the community sector.

The authors of the report argue that this degree of opacity "presents a serious risk that poor and declining quality cannot be quickly identified, particularly in a climate where providers are facing growing demand for their services and significant workforce challenges”. 

Many respondents to a survey send to 250 leaders in the community sector listed staff shortages and caseload sizes as risks to the delivery of quality care. Financial and demand capacity pressures were also seen as risks to quality both now and in the future. 

The report calls on national bodies such as the Department of Health, Trust Development Agency, Care Quality Commission, Monitor and NHS England to “develop and implement a clear road map for radically improving quality measurement in community services”. 

It also recommends that a much stronger focus be made on quality in community services, particularly as the needs of people using these services become more complex. 

The NHS Confederation welcomed the report. Matthew Winn, chair of its Community Health Services Forum, said: "All types of community services provider, whether in the statutory, voluntary or independent sectors, work hard to measure, monitor and improve the quality of services they deliver. Frustratingly, the continuing lack of nationally standardised measures makes it harder to demonstrate the impact community health care professionals make every day with patients, and provides the ideal excuse not to shift more care into community settings.

"It is vital that national bodies such as Monitor, the TDA, the HSCIC and NHS England give higher priority to the urgent implementation of a strong set of national measures for community health services.

"A good place to start would be putting their collective weight behind a firm commitment to enabling the Community Information Data Set to be used at national level from April; this must not be postponed yet again.

"The national bodies should support and work with the Community Indicators development programme, set up – and, so far, funded solely by – community providers themselves. We also need to look seriously at how to support the IT and infrastructure needed to gather and use data well across community services."

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