Future of the health service: the era of community care has arrived Quality for patients at home or in the community is becoming a reality, but success depends on investment in staff and services.
It is well known that there is growing pressure on the health and social care system. There is a rising and ageing population that, if our care system does not change, will require an additional 13,500 hospital beds to soak up demand.
There is already a tendency for patients to end up in hospital when they could be cared for elsewhere. The ambition to move care closer to home is not new – it has been our ultimate goal for many years – but major change is needed to achieve it.
A great deal rests on community services: they could transform chronic disease management, support reductions in the number of people admitted to hospital and how long they stay there, and help primary care meet a growing demand.
Government initiatives, including the grandiosely-named 2008 'Transforming community services programme', have all failed to achieve this aim, remaining largely concerned with the structure and ownership of community organisations while the services themselves were neglected.
There is now an emerging consensus about what we need to do next, and there are some common features to the new service models being developed. The first step is to reduce complexity of services. Confusing, overlapping and unclear provision, with many professional silos working in isolation, needs to be unravelled and multi-disciplinary teams with mental health and social workers created.
We also need to wrap services around primary care practices and natural local communities. A common problem is the lack of contact between community staff and GP practices. They will both work more effectively if this is reversed. In some areas social services have changed their team structures to match this.
To make the most of these stronger ties, teams need support from specialist medical and nursing experts. This implies some changes in how consultants work – particularly among those caring for older people and patients with chronic conditions.
Another key step is to create services that offer an alternative to hospital stay, and that can respond more quickly than many currently do. At least 20% of admissions and half of days in hospital can be cared for in other settings, including the home. Where new models are developing, community care teams are intervening quickly to prevent admissions, diverting patients away from A&E or working with hospital wards to speed up patient discharge.
GP services are also changing, with more practices working together in federations and networks and sharing records between health professionals and social care teams. Together, these changes should provide better care, especially for people living nursing or residential homes.
A shared care plan for each patient that is available to the ambulance service can also help prevent trips to hospital.
To be successful, howerver, there will need to be significant investment in developing the workforce and dealing with the impending shortage of community nurses. Hospitals will also need to adapt and find new ways to work with these more responsive providers.
Most importantly, all these services will need to find ways to increase their reach – working with the voluntary sector and local government to harness the power of the wider community to help keep people connected and supported.
Nigel Edwards is a senior fellow at The King's Fund Guardian Professional.
It is well known that there is growing pressure on the health and social care system. There is a rising and ageing population that, if our care system does not change, will require an additional 13,500 hospital beds to soak up demand.
There is already a tendency for patients to end up in hospital when they could be cared for elsewhere. The ambition to move care closer to home is not new – it has been our ultimate goal for many years – but major change is needed to achieve it.
A great deal rests on community services: they could transform chronic disease management, support reductions in the number of people admitted to hospital and how long they stay there, and help primary care meet a growing demand.
Government initiatives, including the grandiosely-named 2008 'Transforming community services programme', have all failed to achieve this aim, remaining largely concerned with the structure and ownership of community organisations while the services themselves were neglected.
There is now an emerging consensus about what we need to do next, and there are some common features to the new service models being developed. The first step is to reduce complexity of services. Confusing, overlapping and unclear provision, with many professional silos working in isolation, needs to be unravelled and multi-disciplinary teams with mental health and social workers created.
We also need to wrap services around primary care practices and natural local communities. A common problem is the lack of contact between community staff and GP practices. They will both work more effectively if this is reversed. In some areas social services have changed their team structures to match this.
To make the most of these stronger ties, teams need support from specialist medical and nursing experts. This implies some changes in how consultants work – particularly among those caring for older people and patients with chronic conditions.
Another key step is to create services that offer an alternative to hospital stay, and that can respond more quickly than many currently do. At least 20% of admissions and half of days in hospital can be cared for in other settings, including the home. Where new models are developing, community care teams are intervening quickly to prevent admissions, diverting patients away from A&E or working with hospital wards to speed up patient discharge.
GP services are also changing, with more practices working together in federations and networks and sharing records between health professionals and social care teams. Together, these changes should provide better care, especially for people living nursing or residential homes.
A shared care plan for each patient that is available to the ambulance service can also help prevent trips to hospital.
To be successful, howerver, there will need to be significant investment in developing the workforce and dealing with the impending shortage of community nurses. Hospitals will also need to adapt and find new ways to work with these more responsive providers.
Most importantly, all these services will need to find ways to increase their reach – working with the voluntary sector and local government to harness the power of the wider community to help keep people connected and supported.
Nigel Edwards is a senior fellow at The King's Fund Guardian Professional.
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