NHS Trust chief executives and chairs believe that community services do not receive the same level of focus, and are not prioritised in the same way, as other sectors.
A report by NHS Providers – Community services: taking centre stage – surveyed 51 NHS Trusts, and around a third of all Trust leaders, on the state of community services, and found that 93% of respondents believed that community services ‘receive less national focus, priority and attention’ compared to other sectors.
One Trust leader, quoted within the document, believes that the lack of a forward view publication – similar to that given to general practice – ‘is reflective of the value placed upon community services’.
Just over three quarters stated they were ‘worried’ or ‘very worried’ that there will not be enough resources or investment over the next five years to deliver the acute to community shift in care.
The report outlines reasons as to why the ‘ambition’ of treating more patients in their own home has not been achieved.
As well as ‘insufficient profile and prioritisation’, outlined by the NHS Trust respondents, the analysis also concluded that there is ‘insufficient understanding of community services at a national and local level’, as well as ‘worrying shortages’ in key staff groups such as district nurses and health visitors.
It also proposed that the focus on cost savings is damaging the perceived value of community care, with a shift required to change this perspective.
It says: ‘The focus on the value of community services needs to shift from cost savings to improving patient care and benefiting society. It should be the case that the public is concerned when a patient is admitted to hospital in the first place, rather than about discharge delays. The narrative needs to be shifted.’
NHS Providers also claims the lack of ‘visible leadership’ for community services within NHS England, NHS Improvement, and Department of Health and Social Care hurts their ability to put across their value to commissioners, a problem exacerbated by ‘fragmented commissioning’.
‘On average, Trusts providing community services were commissioned by more than five different organisations, and for some this was as high as 10 commissioners. This fractured nature of commissioning creates additional burden for organisations…and also means that commissioners will not necessarily have a strategic focus around community services,’ the report adds.
Chief executive of the Royal College of Nursing, Janet Davies said that investment in district nursing ‘must be a priority’.
She said: ‘For too long community services have been left out in the cold. Despite promises to help people stay well in their own homes, years of underfunding and staff shortages has left community care in a precarious state.
‘NHS leaders are facing tough decisions but cutting community services places more pressure on emergency care and patients are paying the price. Crucial finances and time have also been wasted on outdated and burdensome retendering of services.
‘Investing in an expert district nursing workforce and community services must be a priority to ensure safe, effective, person-centred care.’
Data from the Queen’s Nursing Institute last year found that the number of new district nurses are ‘not sufficient’ to replace those retiring.