The QualityWatch report on community services is a timely reminder of the challenges facing the NHS as it endeavours to transform care delivery. The Five Year Forward View sets out the challenges facing health and care, the necessity for change and the direction of travel towards integrated and accountable care.
This is not unique to the UK. There are great case studies from Spain, Israel, New Zealand and the USA. All of the successful ones, that I have studied, require high quality ‘community services’. Critically, they are working in an integrated manner with General Practice and specialist services (which are mostly, but not universally, based in hospitals). The successful examples see Primary Care as being a function delivered by an integrated General Practice and Community services workforce.
We measure activity and quality most intensively in the hospital sector and this report highlights the paucity of information not only about the quality of community services, but also their value. The same holds true for General Practice and, while we are at it, let’s add mental health and social care.
If the NHS is serious about wanting to shift to a system of accountable care then it requires transparency of information from providers across the continuum of care. This permits the value they are contributing, and for which they can be held accountable, to be determined. Both quality and cost need to be tracked for a population so that the health of that population can be supported in the most effective way. Community services cannot deliver best value if General Practice or the hospital services are not functioning in a way to support both effective and efficient care.
What strikes me is that integrating services across a geography, without the information and analytics to support high-value care, is like trying to run a really busy airport with no air traffic control. The lack of transparency as to what is happening outside of the hospital sector is damaging to community services and patients. It damages the services because they are unable to evidence their value to the system and so do not receive the recognition, voice and investment they deserve.
More importantly, it is damaging to the patients through unwarranted variation and ineffective investments in care and, as this paper concludes, we cannot “continue to ‘fly blind’ on care being received by millions of patients every year”. Neither can we continue to focus on single components of the system. If we are to really put the patient at the centre of holistic care we need an holistically managed system.