Autumn In-Brief 2018 V10 FINAL - Flipbook - Page 6
The changing shape of community services
Evaluating the shifting landscape – Jenny Treanor
In the late 1980s I worked as a senior nurse for a Midlands
health authority which provided acute, community and
mental health services. We worked together across an
area, coterminous with our local authority and it felt like we
all got along pretty well, focusing on delivering effective
services to our very deprived local community and not
having to worry about commissioners, competition … or
austerity.
Our own small, excellent public health and health
promotion teams had a close focus on the health needs of
our local population. We had a number of elderly care
wards with their own geriatricians and the odd day hospital
too. We trained our own nurses. We even had a staff
canteen in the building where we met to eat bacon
sandwiches, build good working relationships and catch up
on the latest gossip. And of course, the sun always shone.
My memory may deceive me on the last point, but the rest
I can remember distinctly.
Today it can be hard to keep track of the latest trends in
the health services market and the rationale behind these.
There are times when it feels like those trends have gone
full circle. Some of the most significant changes in the
provider landscape have taken place within and across
those organisations who provide community health
services. Just a few years ago the majority of these
services were delivered by standalone community trusts;
created following the 2011 Transforming Community
Services (TCS) initiative.
Acute, MH +
Community
Acute +
Community
MH, LD and
Community
Acute
The above chart only tells part of the integration story.
Community trusts are increasingly being integrated with
social care in a spectrum ranging from minimal up to full
integration of NHS and social care organisations. A
number of innovative approaches have emerged
including that at North Devon where the local provider
became the first NHS Trust to manage domiciliary care
services, taking them over from their local authority.
Many other changes are having an impact in shaping
what and how these vital services can deliver. These
Most of these community organisations became NHS
trusts although a minority became social enterprises. In the changes include demography, medical advances, the
last few years it has become harder for these organisations uncoupling of most community services from their local
GP practices and austerity driven cuts in other services
to survive as standalone bodies with many struggling to
deliver adequate levels of finance, governance and clinical which care for the same client group.
quality. Once again community services are increasingly
Fears about the sustainability of community services
being delivered through a range of integrated approaches. have made this provider type one of the most
Recent analysis undertaken by Niche in the North of
England illustrates this shift quite clearly. There are 41
trusts delivering community services in the area, but just
three deliver community services only.
Not only are standalone community trusts becoming rarer,
standalone mental health trusts are too. Whilst there are 18
trusts delivering NHS mental health services in this area,
there are only four which deliver mental health services
alone. These facts are not unrelated; of these 18 mental
health trusts, 12 now additionally provide community
physical health services following mergers/acquisitions
of/with local community health services.
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reconfigured sectors of the NHS in the last 10 years. The
effect of these changes on service delivery, and on the
often change-weary staff who are working to everincreasing demands, should not be underestimated.
The key factors driving change
These changes are being driven by a number of national
and local factors which include national policy directives,
the five year forward view and STPs. But there are other
key factors driving this including commissioner
approaches and behaviour and the emergence into the
market of a number of independent service providers.