NHS staff across England are taking control of the community services they deliver in a drive to improve outcomes for patients and transform patient care, the Department of Health has announced.
From April next year, all Primary Care Trusts should have separated the commissioning of community services from their provision. All staff and services will be transferred to a range of new organisations such as aspirant Community Foundation Trusts and Social Enterprises, or integrate with existing providers. This is part of the Transforming Community Services programme which will deliver more personalised care closer to home.
Community services provide essential care to many people in vulnerable circumstances, families and communities, from health promotion to end of life care. The service is an integral part of the local NHS, employing around 200,000 staff and representing around £10bn of NHS spend.
The new organisations will provide more choice for patients and have a vital role in the transfer of care and treatment from hospital settings to help patients with their recovery or manage their healthcare needs. The organisations will support the NHS in its drive to improve quality and productivity, by encouraging clinicians to innovate to transform services, promote healthy lifestyles and focus on prevention.
Implementation of these plans will require real change management expertise, clinical engagement and patient input, to ensure completion of transfers prior to the end of March.
26 per cent of the value of community services currently provided by PCTs will, in the future, be provided by Community Foundation Trusts, and a further 10 per cent by Social Enterprises. Both of these innovative models have a strong emphasis on community involvement so that they are truly accountable to patients and led by local decisions.
Community Foundation Trusts will be financially more independent but still part of the NHS family. Eight have already become NHS Trusts and are on their way to gaining Community Foundation Trusts status, with up to another eight to follow.
Community services will also be provided by integrating community services with acute or mental health services. Both of these models have their benefits in providing patients with joined up care or forging strong local authority partnerships.
Simon Burns, Minister of State for Health said: "The proposals we set out in the White Paper aim to put patients at the heart of the NHS, giving them more choice and better control over their care. These changes to community services will enable clinicans to deliver personalised and responsive care and better outcomes for some of the most vulnerable in our society.Frontline staff will be in the driving seat to improve quality and integrate services to ensure the most effective outcomes for their patients. And there will be further benefits - frontline staff are best placed to provide the most efficient services so that local NHS money goes further. Plans are in place for Social Enterprises to provide almost £900m of services a year a major step towards our ambition to create the largest and most vibrant social enterprise sector in the world."
The staff-led social enterprises will be set up under the Right to Request scheme where over 25,000 NHS staff are expected to transfer to these new local organisations. Three are already up and running - in Hull, Kingston & Leicester.
Ian Dalton, DH Managing Director of Provider Development and Chief Executive of North East SHA, said: "These plans provide firm foundations for transforming these key services and speeding up the transfer of services out of hospitals and in to local communities and people's homes.The range of options chosen - including 16 aspirant Community Foundation Trusts and over 60 Right to Request social enterprises - shows the enthusiasm of local NHS staff for taking control of improving services for patients. These are potential 'hot-beds' of innovation and community engagement - but this is only the beginning. The hard work starts now as boards sign off business transactions and plans are completed, and the NHS gets underway with setting up new organisations. They will be able to empower staff to lead change and transform services and working practices."
The NHS currently spends around £10 billion a year on services provided within the community, of which £8.5 billion (as represented by the pie chart above) is currently directly provided by primary care trusts. It is these services that PCTs are working to divest themselves of.
As at 25 November, 98 per cent of these have either already transferred or have been agreed by the Department and are moving towards their final form by April 2011. We expect to agree the remaining three approved in December 2010.
Cambridgeshire Community Services NHS Trust (CCS NHST) became the first community NHS Trust on 1 April 2010 (so already separated from local PCT).
CCS NHST plans to undertake a formal public consultation in Jan - March 2011 as part of its application for NHS Foundation Trust status.
Examples of how it is improving services already
CCS NHST has introduced a Re-ablement Service in partnership with their local authority, to improve the independence and quality of life for many of their patients, as well as reducing inappropriate hospital admissions. (Re-ablement is a short term free service aimed at providing support to individuals wanting to regain independence following a spell of ill health or a hospital episode)
CCS NHST is working with the hospitals to provide more services in the community or directly in peoples homes, including diabetes care, musculo-skeletal services and minor oral surgery. Results to date include easier access for patients, more choice, reduced waiting times as well as savings to local health economy. Plans are underway to shift podiatric surgery and sexual health services to community locations.
Future plans include:
* Improving health and social care services for children and adults, supporting people living with long term conditions (e.g. diabetes) through self-management programmes
* Expanding use of telecare/ telemedicine, including leading edge technology that enables remote monitoring and a speedy response to fluctuations in patient's vital signs
* Specialist palliative care services: providing end of life care and therapies in the home setting and ensuring people have choice about treatment at the end of their life and the place of their death. (The National End of Life Care Intelligence Network's report 'Variations in Place of Death in England' ranked Cambridgeshire in the top 5 nationally, in terms of supporting people to die in their place of choice. Our services are central to this achievement ).
* Health visiting services: transformation programme underway moving away from a target-focussed service to one that supports families give children the very best start in life
CCS NHST is also embarking on a programme of work to establish itself as a University Trust, focussing on research, education and teaching to improve quality of care and outcomes for local people.