Securing the future: A renewed emphasis on community services | Phil McCarvill

Phil McCarvill

A new report into health and social care funding has concluded that strengthening provision in local communities and in people’s homes will be key to reshaping health and care services over the next 15 years. Dr Phil McCarvill, chief adviser at the NHS Confederation, explores the issues.

A number of things are evident from A number of things are evident from Securing the future: Funding health and social care to the 2030s, published last month by the Institute for Fiscal Studies and Health Foundation and commissioned by the NHS Confederation.

First, the report lays bare the scale of the demand and financial challenges facing the NHS and social care system over the next 15 years:

  • UK spending on healthcare will have to rise by an average 3.3 per cent a year over the next 15 years just to maintain NHS provision at current levels, and by at least 4 per cent a year if services are to be improved.
  • Social care funding will need to increase by 3.9 per cent a year to meet the needs of an ageing population and an increasing number of younger adults living with disabilities.

Second, it shows that without a radical change of emphasis, these demand pressures would require an unprecedented increase in acute care provision. “The combined effect of population growth, ageing and an increased burden of chronic disease is that hospital activity will grow substantially over the next 15 years,” the report says. “Our model projects that in the status quo scenario, emergency admissions would almost double over the next 15 years.”

And third, it highlights that while much of the media and political interest in the report has focused on the financial implications, the real message to emerge is that if we want to avoid having to dramatically increase hospital provision, what is really required is a fundamental rebalancing of the delivery of care: “Alongside any increased funding, significant changes would need to be made to use resources well. If the NHS is not to build a substantial number of new hospitals to meet rising demand, care models will need to be transformed so that care is based closer to people’s homes.”

It concludes that a sustainable, high-quality healthcare system is likely to involve more focus on supporting primary and community services, not less.

Shifting the balance
Rebalancing care will require an unprecedented shift in emphasis. “Without significant changes to demand through better disease prevention and health promotion action and/or radically different models of care. While it may be possible to ‘bend’ the demand curve, our projections show that changes would need to be very substantial if acute activity were not to increase.”

This report should help set the agenda for health and care leaders over the next decade. It should trigger a system-wide conversation about the right balance of services in hospitals, community services, mental health, ambulance services, primary care and social care. At the centre of this conversation must be what is right for the people who use and rely on health and care services. Our sense is that what is best for the individual, care closer to home, is also likely to be better for the system.

So how do we begin this process?

There are a number of initial steps that will get us off on the right footing:

  1. Improve the quality of data collected across all NHS community services so that we can measure performance, impact and outcomes. This will enable us to make better decisions about the types of services that are commissioned and delivered.
  2. Significantly increase investment in services which support us to keep people well and safe at home for longer, prevent the development of long-term conditions before they emerge and ensure that we are reserving acute care for those who really need it.
  3. Stop kicking the social care can down the road and devise a long-term solution for social care funding.
  4. Commission and deliver higher acuity services in local communities and in people’s homes so that we can support more people, with more complex health and care needs, to remain at home and in their local communities, rather than being routinely admitted to hospital.

The logic is clear, what is needed now is to back this worldview. That is why, the NHS Confederation and NHS Providers have joined forces to develop the new Community Network. The network brings together NHS community trusts, community interest companies providing NHS community services and combined acute and community and mental health and community services.

Together, we want to strengthen the focus on community services and enhance key relationships between community services, primary care and social care because we know that this will be vital to transforming care so that we have a 21st century health and care system that meets the needs of our 21st century population.

The publication of Securing the future and the birth of the Community Network are important developments for those of us who have been making the case for enhanced provision of community services. As the report concludes:  “We can only achieve the shared goal of a reshaped health and social care system by strengthening provision in local communities and in people’s homes.”

To find out more about the Community Network, contact Phil McCarvill – @phil_mccarvill.

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