Gill Morgan writes that
community healthcare needs more prominence as the NHS moves forward. This article is taken directly from her piece for the HSJ online
(19th Aug 15).
Community health services used to be most people’s experience
of healthcare. But one of the aspects of modern medicine’s wondrous
advance has been that its technical and scientific achievements were
concentrated in institutions.
Let us be in no doubt that the, at times, quite breathtaking quality and
complexity of care that can only be provided by hospitals is an
essential part of the healthcare system. But we must also recognise the
breadth and sophistication of what can be accomplished by
community and primary care services.
Recognise community care
Healthcare in the latter part of the
20th century became so dominated by hospitals, bricks and mortar that
we now struggle to explain to people the virtues of providing care
outside of hospital. In fact, we now have a phrase for it – out of
hospital or OOH – as the notion is so remarkable to some.
I think
we should change OOH to out of home. Healthcare at home, in clinics,
surgeries and pharmacies should be seen as the default and desirable
place for most people’s healthcare with only intense need, high risk and
specialist intervention requiring the unique abilities of a
hospital.
Community health services lack the high public
profile of other NHS services, and yet they often reach the deepest into
our lives. They are part of our neighbourhoods, they come into our
homes, and are with us for the long term.
We live longer now
than ever before, but are more subject to frailty and long term
conditions as a result. Community health services partner with
colleagues across the NHS and in
social care, education, charities and
local government to personalise care packages which support people to
maintain their independence for as long as possible.
Their
personal, community based approach means they take many different forms,
and are often organised to meet local patients’ and service users’
particular needs. Their underpinning philosophy is to help people live
as independent and fulfilling a life as possible, for as long as
possible.
Yet their role has never been well defined or as widely recognised as
other parts of the NHS. Partly, this is due to the various forms they
take: working so closely with GP services, they are often assumed to be
part of the surgery. They are also rarely in the spotlight, lacking the
propensity to make headlines, impact elections or generate national
controversy.
Consequently, their potential to provide the
sustainable core of the NHS and drive new models of care can be
under-recognised. In effect they are usually described in the context of
other services, rather than in their own.
To deliver better and
new models of care it is essential that we unleash the community health
sector’s potential. This needs a new vision which explicitly recognises
and encourages its role; new currencies to describe, measure and fund
their work; and a language to explain, promote, measure and expand it.
Self-sufficiency,
self-awareness and self-care (with the right knowledge, technology and
local backup) will have a massive impact on keeping people healthier and
helping them live with manageable conditions.
This will need
commitment, leadership, and an NHS freed to develop and move to new
models of community based, person centred care and provide the services
that can only be delivered in a hospital at the same time. As part of
this commitment we will publish
Community Health Services – A Way of Life, a narrative to support and drive the conversations and plans for new models of care and sustainable NHS services.
We need to talk the language of community health so that we can benefit from its current and future potential.
A new language and context
Community services need to be described in their own language. The NHS must see its mission as being about people, not patients.
People
live with increasing health needs and frailty, but we too often see
patients for whom a health transaction is the necessary fix. Until the
NHS is oriented around people and their needs, rather than episodes of
care, it won’t be able to address challenges of quality or cost.
Currencies
and timescales need to be fit for sustaining long term relationships in
neighbourhoods, and across health and social care. Integration should
be an outcome benefit experienced by the person; not simply an
organisational design principle or administrative convenience.
A community approach
Commissioners will need to offer consistency and a long and integrated view in their
commissioning and tendering behaviour.
Trust
boards and commissioners will need to pioneer and use different forms
of information to assure themselves that services provided in the home,
away from a hospital, are safe and provide service users with a positive
experience of their care.
Regulators should seek to change their working models, to gain
assurance that trusts providing community health services are well led
and that agreed standards of care are met in different ways to the
traditional hospital setting they are used to. This will require a new,
sensitive approach to evaluating patient and service user feedback.
How will
regulation and inspection processes change when the care setting is increasingly an individual’s private home?
Right workforce, skills, recognition and rewards
Providing support to stay healthy (or live more comfortably with ill health) needs additional and adapted roles and skills.
Different
skills are needed to work in homes and high streets. Healthcare
professionals will increasingly work alongside other care, support and
advice professionals, using new approaches to relationship building and
collaborative working.
Being locally responsive, neighbourhood based and person focused does not happen automatically. It requires:
- skilled professionals;
- well managed and led organisations; and
- strong and meaningful relationships between agencies and committed commissioners.
Community
indicators that work for the NHS, but also are meaningful to its
partners, will be a key element; as will core competencies of
professionals and organisations.
The NHS seeks to be invited to be
guests in the everyday lives of people, rather than only being there
for when things go wrong. Community healthcare services excel at this.
It
may seem odd that we are having to relearn an approach we were once
good at, but this will become a way of life and a way of sustaining
better, healthier, independent living for longer.
Gill Morgan is chair of NHS Providers
