Primary Care Trust Network. Community health services Making a difference to local communities

Transcription

1 Primary Care Trust Network Community health services Making a difference to local communities

2 The Primary Care Trust Network The PCT Network was established as part of the NHS Confederation to provide a distinct voice for PCTs. We aim to improve the system for the public, patients and staff by raising the profile of the issues affecting PCTs and strengthening the influence of PCT members. The NHS Confederation is the only independent membership body for the full range of organisations that make up today s NHS. Its ambition is a health system that delivers first-class services and improved health for all. As the national voice for NHS leadership, the NHS Confederation meets the collective needs of the whole NHS as well as the distinct needs of all of its parts through its family of networks and forums. The PCT Network is one of these. The PCT Network has established a PCT Provider Services Forum to ensure a strong, influential, national voice for community services and to enable the development and sharing of good practice. The Forum is led by leaders of PCT provider services from each region and regularly holds national meetings for members on topical issues. For further details of the PCT Network or the PCT Provider Services Forum, please visit or contact elaine.cohen@nhsconfed.org The NHS Confederation 29 Bressenden Place London SW1E 5DD Tel Fax enquiries@nhsconfed.org Registered Charity no Published by the NHS Confederation The NHS Confederation 2009 This document may not be reproduced in whole or in part without permission. ISBN BOK This publication has been manufactured using paper produced under the FSC Chain of Custody. It is printed using vegetable-based inks and low VOC processes by a printer employing the ISO14001 environmental accreditation.

3 Contents How do community health services make a difference? 2 What are community health services? 3 Community health services in practice 5 Community health services working with local authorities and other partners 11 Conclusion: the policy context 12 References 13 Acknowledgements 13

4 02 Community health services: Making a difference to local communities How do community health services make a difference? Key points Community services are a crucially important, if little understood, part of the NHS. Community services are a key part of the shift to delivering more personalised care, closer to home. The majority of community services are provided by PCTs, with a cost of over 11 billion per annum. This element of the NHS is one of the most popular with patients and is vital in supporting patients recovery from illness and leading efforts on preventative and wellness services. Community health services make a difference in three main areas: keeping people independent keeping people at home longer allowing people to leave hospital sooner. Community health services make a valuable contribution to ensuring the health and well-being of society. They can make a difference to local communities, providing personal care which is based on building a longer term relationship between patient and health professional. They provide invaluable local services for managing long-term medical conditions, such as diabetes, as well as preventing serious illness and acute episodes. This is the first report from the PCT Provider Services Forum. It is intended to illustrate the range and breadth of community health services provided by the NHS with partners.

5 Community health services: Making a difference to local communities 03 What are community health services? Community health services are those NHS services delivered in a community setting or in the patient s home, and which serve the health and well-being needs of the local population. Community health services cover cradle to grave services, which many of us take for granted. At some point in their lives, most people will come into contact with community health services. These services cover an extensive and varied range of personalised services costing over 11 billion per annum. 1 National statistics are difficult to obtain both because of the way that information is presented and because there is no single standard model of provision. Community health services can help support patients to recover from illness or lead efforts on preventative and wellness services. The services provided are wide-ranging and varied. The scale of community health services Community health services, along with primary care, form the bedrock of services in the NHS. Ninety per cent of contacts between health professionals and patients occur in these settings. This amounts to more than one million contacts between care professionals and patients every 36 hours. The majority of community services are provided by some 250,000 staff directly employed by primary care trusts (PCTs), although some services are provided by independent and third sector organisations and other NHS providers such as acute hospitals. The annual expenditure on community health services is in the order of 11 billion. Core services: community nurses, health visitors Specialist services: podiatry, speech and language therapy, school nursing, health promotion Services provided with other agencies: maternity services, mental health, children s centres, carer support, sexual health, prison health

6 04 Community health services: Making a difference to local communities Cradle to grave : what types of service are provided? There is no single national model for the configuration and range of services provided in the community. Patterns of provision will depend upon the characteristics of the local population, geography and the nature of other services in both the health and local authorities. Examples of the range of community health services are shown below. Children and families Children with disabilities Community maternity services Extended schools Health visiting Safeguarding children School nursing services Health and well-being Audiology Chiropody Dental services Family planning Health promotion Health trainers Minor injury services (walk-in centres) Sexual health services Stop smoking services Rehabilitation Community oncology services Occupational therapy Orthopaedic rehabilitation Physiotherapy Stroke rehabilitation Long-term conditions Adult learning disability services Carer support Community matrons Community rapid intervention services Continence services Diabetes services District nurses Intermediate care services Self care End-of-life care Continuing / palliative care Home support teams Support for carers

7 Community health services: Making a difference to local communities 05 Community health services in practice The vision of those providing community health services is to provide personalised, accessible services that meet users needs and promote health and well-being, by working in partnership with users, communities and local authorities. The values which underpin community health services are shown in the box below. These are examined in more detail on the succeeding pages, illustrated with case studies from the NHS. Community health services allow, perhaps more than any other part of the NHS, the opportunity to develop a longer term and more personal relationship between carers, professionals and the patient Values underpinning community health services Personalised and sensitive to the needs of the individual Responsive to the needs of the local community Accessible to all and delivering care close to home High-quality professional care Safe and reliable services for local people Delivering improvements in key targets such as health inequalities Personalised care Community health services allow, perhaps more than any other part of the NHS, the opportunity to develop a longer term and more personal relationship between carers, professionals and the patient. In part, this is because of the local setting, but it is also founded in the nature of service delivery in the home or as part of a community-based programme. These local services are often tailored to the needs of communities and individuals. Chemotherapy services Walsall Community Health and Walsall Hospitals NHS Trust have worked together to develop a community chemotherapy service. Treatments such as this have previously only been available in the hospital setting. By offering a range of chemotherapy treatments and support in the community or at home,

8 06 Community health services: Making a difference to local communities Community health services play a key part in improving public health in local communities Sport and sexual health Chlamydia is the most commonly diagnosed sexually transmitted infection in England among people under the age of 25. A national programme for Chlamydia screening was launched in Oldham has a higher than average prevalence and it was recognised that more proactive engagement of the at-risk population was needed. specialist nurses are able to provide an accessible and convenient service which is geared around the individual needs of the patient. Patients are offered a choice of convenient location for them to receive their treatment. Choices include the hospital clinic, a community clinic or their own home. Team members are available to visit patients the evening before their treatment, which allows the patient and family/carers to be present and ask any questions before treatment starts. jo-ann.beech@walsall.nhs.uk or nicola.robottom@walsall.nhs.uk Responsive to the needs of the local community Community health services can play a key part in delivering public health improvements in local communities. Community health service provision is responsive to the health needs of people. These services also provide an opportunity to shape the range of services provided, whether they are for weight loss, sexual health, podiatry, counselling or any other healthcare need. Oldham Community Health Services is working with Oldham Athletic Football Club and Oldham Roughyeds rugby team to undertake targeted sexual health education of the playing staff and a mass screening on some match days. Roisin Dargan-Peel at rdarganpeel@nhs.net Sport and childhood obesity Somerset PCT has developed the Do Activity Stay Healthy (DASH) scheme in partnership with Somerset Active Schools Partnership, in response to concerns over the increasingly sedentary behaviour of primary school-aged children. The aim is to increase activity, fitness and general health levels of four to 11 year-olds and reduce childhood obesity. Originally funded by Sport England, the scheme now has further funding from the Football Association. School nurses and sports coaches work with whole families at home and at school and a variety of activities, such as walking, swimming and aerobics, are offered together with healthy breakfasts before the school day starts. tracey.milton@somersetpct.nhs.uk

9 Community health services: Making a difference to local communities 07 Accessible to all and delivering care closer to home Community health services can help make services more accessible to all. By providing care in a local setting, including the home, community health services reduce barriers for those with mobility challenges. For those with other forms of accessibility challenges, such as learning disabilities, community health services can also reduce barriers and the reluctance of patients to access services. Community health services help bring people home sooner and keep them at home longer, and By providing care in a local setting, community health services reduce barriers for those with mobility challenges support people in their wish to die at home. Community health services are supporting much sicker people at home rather than those people being in hospital. Home support teams NHS Western Cheshire has developed a home support team to prevent unnecessary hospital admissions, particularly for elderly and vulnerable people. The team has increased the opportunity for patients to be cared for closer to home. The home support team amalgamates existing rapid response and palliative care teams with

10 08 Community health services: Making a difference to local communities additional investment into generic support workers and mainstream district nursing and therapy services to provide care and reablement to people who would otherwise face an unnecessary admission to an acute hospital bed, or be unable to achieve their preferred place of death if this is their own home. The team works seven days a week from 8:30am to 10:30pm, provides timely and intensive health and social care programmes to people in their own homes, and links overnight to the evening and night nursing service to offer 24-hour care when required. jane.hall@wcheshirepct.nhs.uk STARS Plus In response to the closure of a community hospital, Somerset PCT Provider Services runs the Short Term Assessment and Reablement Service (STARS) which allows people to stay at home rather than be admitted to hospital and enables those who have been admitted to come home earlier. Community health services are systematically governed to protect people and the workforce, and are subject to inspection and regulation by the Healthcare Commission High-quality professional care The drive for high-quality care determines service ambitions. Community health services are delivered by a wide range of health and social care professionals. Professionals from a range of disciplines in both clinical and social care work together in teams to ensure a personalised, integrated service for patients. Community children s nursing As part of its community children s nursing services, Islington PCT employs specialist community nurses to support children with eczema and asthma and their families. The nurses provide services in a local children s centre and in people s homes. They support parents to manage their child s condition and A multi-disciplinary team, working with teams from the acute hospital and social services, provides care at home, such as assessment, treatment and rehabilitation. Individualised plans are agreed with the patient and services are available 24 hours a day, seven days a week. The service promotes compassion and time to care at home in an environment that enables the patient to feel safe and in control. pat.herring@somcomhealth.nhs.uk

11 Community health services: Making a difference to local communities 09 Community-based care, responding to local needs and priorities, can be a key part of the fight to reduce the level of health inequalities reduce the number of visits to A&E and hospital admissions. joan.myers@islingtonpct.nhs.uk Safe and reliable services for the local population Community health services are systematically governed to protect people and the workforce. They are subject to inspection and regulation by the Healthcare Commission (the Care Quality Commission from April 2009) and are rated annually against their performance the annual health check. Diabetes services The diabetes service in Redcar and Cleveland has been held up as a shining example. The Healthcare Commission rated the service as excellent a status only awarded to seven of the 152 PCTs in England. This excellent rating shows the quality of service provided in Redcar and Cleveland (through its community services and general practices) is in the top 5 per cent in the country. Redcar and Cleveland provides a specialist diabetes service in the community, has an established obesity/weight management strategy and, as part of that strategy, runs a GP-referral specialist weight management service. There are also community dieticians and health promotion teams educating patients and the public in healthy eating and lifestyles, and two

12 10 Community health services: Making a difference to local communities of the GPs in Redcar and Cleveland have special interests in diabetes. bev.dredge@mrccs.nhs.uk Driving improvements in health inequalities Much has been made of the wide geographical and social variations in the health of the population. Community-based care, responding to local needs and priorities, can be a key part of the fight to reduce the level of health inequalities. Health trainers The 2004 white paper, Choosing health: making healthy choices easier, 2 proposed the development of a new role for improving health and reducing health inequalities the health trainer. The health trainer s role is about working with individuals to set and manage behavioural goals. Injury prevention for carers Occupational therapists in Central West London Community Services work with their local authorities to support and promote health amongst unpaid carers who may be at risk of injury. The service enables the carers to continue to provide care for adults and children in their own homes. The occupational therapists provide training and education in areas such as how to move and handle the person they care for, stress management and, if appropriate, specialist equipment and training on how to use it. They are also able to signpost carers to other services and support provided by the local authority and voluntary sector organisations such as the Carers Network. melinda.shepherdson@westminster-pct.nhs.uk Walsall PCT has a well established health trainer service which has seen more than 3,500 clients in two years, of whom 70 per cent have achieved their personal goals to lose weight or stop smoking. The principle behind the service is that help is available from next door rather than advice from on high. Planned developments include specialist trainers for mental health and learning disabilities to ensure that the benefits offered by the service are available to all. susan.morgan@walsall.nhs.uk

13 Community health services: Making a difference to local communities 11 Community health services working with local authorities and other partners People with long-term conditions and their carers often need access to a variety of services, which may be provided by a range of agencies including health, social care and other local authority departments. It can be complex to navigate and understand who provides which service. Increasingly, community health services are working in an integrated way to make these joins between services invisible to the client. Positive Steps Oldham Positive Steps Oldham (PSO) is an independent sector company providing an integrated range of services, including Connexions, Oldham Youth Offending Service and Oldham Drugs and Alcohol Action Team. PSO's mission is to enable young people across Oldham to make a successful transition into adult life and fulfil their potential. Its integrated approach recognises that young people may face a number of interconnected barriers to attainment. These could include family or relationship issues, health problems or offending behaviour. Community health services are working in an integrated way to make joins between services invisible to the client Partnership working is central to this approach. In addition to the services it directly delivers, PSO also hosts the strategic management of a number of borough-wide initiatives such as Oldham Drugs and Alcohol Action Team and Oldham Teenage Pregnancy Partnership. jbutterworth2@nhs.net

14 12 Community health services: Making a difference to local communities Conclusion: the policy context The 2006 white paper, Our health, our care, our say, 3 set out plans for a radical and sustained shift in the way in which services are delivered ensuring that they are more personalised and fit into people s busy lives. The strategic direction was: more services in local communities, closer to people s homes supporting independence and well-being supporting choice and giving people a say supporting people with high levels of needs a sustained realignment of the health and social care system. In July 2008, as part of the NHS Next Stage Review, the Government published its vision for primary and community services over the next ten years. 4 The paper focused on how change will be driven by local choices and priorities rather than top-down targets, and how services will be shaped around patients. Key themes are: continuously driving quality and local decisions driving change. Community-based care is popular with patients, but parts of it have been almost invisible to policy makers. 5 As the latest policy vision is implemented, it is important to preserve the features of coordination, continuity and care that make it special. As the latest policy vision is implemented, it is important to preserve the features of coordination, continuity and care that make community-based care special PCTs welcome the increased focus on community services and the establishment of the Department of Health s Transforming Community Services programme. Part of this work is considering how organisations should change to better focus on commissioning and to separate the provision of the services. The best way forward will depend on local circumstances, and the emphasis is on local decisions on governance and organisational models. The publication by the Department of Health of Transforming community services: enabling new patterns of provision 6 requires PCTs to have developed plans for the future of their provider services by October The recent increased national policy focus on community health services is welcome, and it supports the ambitions of service leaders to adopt more businesslike approaches to their services, coupled with improved quality and accessibility. To comment on the issues covered in this report, or for further information, contact Elaine Cohen, Senior Policy Manager at elaine.cohen@nhsconfed.org

15 Community health services: Making a difference to local communities 13 References 1 Department of Health Memorandum to the House of Commons Health Select Committee, 16 November 2007 (HC26i) 2 Choosing health: making healthy choices easier. Department of Health, November Our health, our care, our say: a new direction for community services. Department of Health, January NHS Next Stage Review: Our vision for primary and community care. Department of Health, July What is out-of-hospital care? NHS Confederation briefing, issue 127, November Transforming community services: enabling new patterns of provision. Department of Heath, January 2009 Acknowledgements The PCT Network would like to thank all those organisations who have supplied case studies for this publication.

16 Community health services Community health services, along with primary care, form the bedrock of services in the NHS, and make a valuable contribution to ensuring the health and well-being of society. They cover an extensive and varied range of personalised services at some point in their lives most people will come into contact with them. Community health services can help support patients to recover from illness or lead efforts on preventative and wellness services. This report looks at how community health services are making a difference to local communities, illustrated with case studies from the NHS. Further copies can be obtained from: NHS Confederation Publications Tel Fax publications@nhsconfed.org or visit The NHS Confederation 2009 This document may not be reproduced in whole or in part without permission The NHS Confederation 29 Bressenden Place London SW1E 5DD Tel Fax enquiries@nhsconfed.org Registered Charity no: ISBN BOK When you have finished with this report please recycle it