NHS Reset: Community services 'will not bow' as 'bigger surge' bites

Under the pressures of COVID-19 we have seen a rapid acceleration of integrated care delivered in the community. As the NHS begins to look beyond the initial peak of COVID-19 hospitalisations, community health services are preparing for the next phase of the outbreak with a clear will to both lock in those transformations which are working well, and to bring additional services back online safely for staff and patients alike.

Looking back on Phase One: Preparation

Community services are playing a leading role in the NHS’ response to coronavirus, without which the health service simply could not have coped. Community services have been able to support thousands of discharged patients and freed up much-needed hospital beds in preparation for the peak of the outbreak.

Community providers have also been working hand in glove with the social care sector, including supporting care homes with protective equipment, staff shortages and training on key areas like infection prevention and control. In some respects, this has been the acid test of successful collaboration across health and care.

Transformation under pressure

There is much to celebrate in the community sector’s response to COVID-19.

A number of community-specific elements of the NHS long-term plan have been accelerated by the pandemic. Community services adapted discharge processes in days (in some areas this had been an ambition for years) and are now caring for more patients with higher acuity and more complex needs than ever before. Embedding this model after the crisis response period will be key, but we’ll need to work out the legislative framework and pooled funding arrangements to ensure its success.

There has also been a rapid move to telephone and video consultations where appropriate, particularly for care homes, as well as additional support for high risk individuals shielding at home, in collaboration with primary care. In fact, the digital transformation and integration with primary care we have long needed has in many areas been accelerated by our response to the virus.

Of course, like everyone in health and care, community services have had to flex, but our colleagues have done so astoundingly. Following national prioritisation guidance, some services were stopped or partially stopped so that staff could be re-deployed, with appropriate training, to more urgent tasks. This provided welcome flexibility and released capacity to enable the discharge to assess model.

We are confident we do have the capacity and the abilities to adapt, and not just in the short term.

The challenges

Of course there have been significant challenges. Distribution of personal protective equipment – especially to the more than 50,000 health and care organisations outside of the main NHS trust supply chain – continues to be challenging, as does access to regular testing for all NHS and social care staff which would enable effective infection prevention and control.

We must also recognise this is a time of great intensity and stress for our workforce – it is important we have the tools to look after them both now and in the future.

There is evidently a need for much greater infrastructure and support in place for care homes and their residents and staff. Community services stand ready to play their part in this alongside colleagues in primary care, building on existing good local relationships under the acceleration of a pared back “enhanced health in care homes” package recently brought forward from October to May implementation.

Looking ahead to phase two: Recovery

As the NHS starts to look beyond the initial peak of the outbreak and plan for the second phase of COVID-19 response, the community sector is bracing itself for an even bigger surge of demand.  It’s true that in some areas this has put a strain on capacity. However, our experience is not that community services will “bow” under the pressure, but adapt, innovate and transform. 

We will see increased demand for community health services for the foreseeable future as:

• more patients who have recovered from COVID-19 are discharged from hospital and need ongoing support
• at the same time as non-urgent planned care is reintroduced and non-COVID-19 patients need rehabilitation in the community
• pent up demand for services will be released as lockdown restrictions ease
• essential community services will start being phased back in where local capacity is available
• care homes will need much greater support and shielded patients will need ongoing support particularly as long-term confinement may create different risks to both mental and physical health.

So, when we think about restarting community services that were deprioritised initially, we need a small set of national priorities so that the community sector can work with partners locally to decide what needs to be brought back on stream when.

The tone of the recent letter from Simon Stevens and Amanda Pritchard was helpful in this regard, and reflected feedback from the Community Network and others. This locally determined, phased approach must be driven by system-wide demand and capacity planning before we turn the tap on elective care. The new Seacole centre in Surrey – the Nightingale of community care – is one model of providing extra community inpatient capacity to manage these competing pressures, but there is no one size fits all response.

Everyone across the NHS will be keen to make sure we lock in the good innovation and reset to a “new normal” effectively. Longer term, this might include developing a legislative framework and pooled funding to support the continuation of the rapid discharge to assess model after the emergency period. Other positive by-products of the pandemic are the increased use of digital technology and renewed impetus to work together with primary and social care colleagues to support our most vulnerable.

As a Community Network, we are supporting NHS England and Improvement to understand the transformative benefits this crisis has accelerated – as well as the difficulties  – and to hang on to those new and beneficial ways of working of our staff, and our patients, for the longer term.

Andrew Ridley is chair of the Community Network, which was established by the NHS Confederation and NHS Providers. He is also the chief executive of Central London Community Healthcare NHS Trust.

This article was first published in the HSJ.