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Realising the Community Dividend – The NHS Challenge

“Realising the Community Services Dividend”

I wrote this piece last year for a different audience so some of the language may be uncomfortable or unfamiliar to some of the Leaders4Leeds group. I hope the main themes are consistent with our ambitions. If not – let me know!

Most care in the NHS is provided in people’s homes and communities. Over 250,000 people are employed in the sector in England. Community services operate from a position of some strength. The impact of NHS reform requires serious consideration if we are to realise the dividend of having community services delivered at industrial scale in almost every home and in every community inEngland. This is equally true in Leeds.

NHS Community Services:

 1)     Have the potential to be  consistent with what patients and the public say they want.

 Work undertaken to deliver the NHS Constitution and local engagement strategies in World Class Commissioning highlight that patients want to be seen:

  •  In their own home or community
  • At a time of their choosing, with good access
  • To someone who knows them, is appropriately qualified and respects them
  • Who works in a team that share data and information
  • With excellent hospital care when needed.

2)     Will be needed to reflect increasing needs/demand

Demographic changes play into the core services provided in the community:

  •  The birth rate is increasing every year–  health visitors, family and school nurses working better with council services;
  • Children with complex needs are surviving into adulthood  – whole community teams
  • Chronic disease is  increasing – Long Term Condition management in integrated teams
  • Exponential increase in older people – complex and co-ordinated health and social care

3)     Have a role in the public’s health

We need to change our offer and change behaviour and lifestyles, work with people who have a long term condition to keep them well and provide support to families through a new universal offer.

  •  Universal health – including the best start in life and improvements in parental capacity [as required from the Marmot Review]
  • Prevention – smoking, alcohol and exercise/obesity services offered in new ways [as set out in the Public Health White Paper]
  • Reducing the impact of disease on health inequalities – better management of people with Cardio Vascular Disease, Cancer, Coronary Heart Disease [see the Joint Strategic Needs Assessment]


4)     Are at the heart of the “Nicholson Challenge”  

Taking 5% of costs out of the system each year means that there will need to be a new system, with better management of and support for patients at risk. The aim must always be to get people into a planned pathway of care.


  • Better Long Term Condition management and integrated care for the elderly to avoid admission – risk profiling, integrated teams, co-production [as described in Sir John Oldham’s work]
  • Improved planned care – delivering Care Outside Hospital, e.g. Intravenous treatment [see NHS Institute Care Outside Hospital programme]
  • Improved Urgent Care, including emergency responses and intermediate care [see Royal College of General Practitioners Work]
  • Improved end of life care [see “Healthy Ambitions” publication]

 5)     Are people based, with an ethos of Care

 Community services focus on the whole person, working in their homes and in their lives changes the deal between the practitioner and professional, with more control being retained by the person:

  •  They have a culture of care that differs from “institutionalised” care
  • They embrace “Co-production” opportunities [ in Leeds this is een in our work with the National Endowment for Science Technology and the Arts; as well as with Leeds University]
  • Increasingly they see integration with other services as a necessity, with opportunities for greater coherence and less overlaps

6)     Are at the heart of communities, delivering sustainable solutions


Community services work with everyone, everywhere – from the hospital to home; from the streets to the prison; from the health centre to the local school. There are already elements of the big society to draw on, and social enterprise:


  • Community services work closely with other partners – voluntary sector, GPs, LA staff – and play to the “big society”.
  • they engage some of the most vulnerable people in society
  • they are local employers, with training and research offers

7)     Work professionally and at scale, in a new market

Transforming Community Services has seen a new professionalism in the delivery and management of community services. Every service has been benchmarked and assessed, with new governance models. The move to new providers sees:

  • Real efficiency programmes, backed by the productive community series
  • A genuine market for providers to operate in
  • Information and benchmarking not seen previously


Realising the Community Services Dividend

 This requires conscious decisions to be made about the design of services in the NHS and social care [and beyond]. We advocate and support:


  1. Community services being at the heart of reform, meaning more of a voice in the debate about NHS and Social Care Reform;
  2. The ongoing focus on delivering improvements in the public’s health, with a broader perspective from Health and Wellbeing Boards;
  3. Recognition of demographic changes on the demand for community services across all age groups but particularly children and older people reflected in commissioning plans;
  4. Harnessing the programme on Health Visiting to drive improved services for children, universal and targeted, to increase parental capacity and improve their health.
  5. Delivery of proven methodologies for QIPP relating to older people and long term condition management, including integration of health and social care;
  6. The opportunity to drive cultural improvements around care, through increased community rotations for all staff during training and vertical/horizontal integration;
  7. Locally based solutions to partnerships with the voluntary, private and statutory sector, supported by the Health and Wellbeing Board
  8. Increased service integration being the principal test for competition, with service footprints being defined in any service procurements


Rob Webster


Leeds Community Healthcare

1 Response

  1. admin

    The one thing that Community Services often seem to overlook? The role of the community in providing care. I witnessed a conversation between a community psychiatric nurse and 3rd sector care provider discussing what support my father in law required to help manage his dementia. Help with cooking, cleaning and laundry, check, check, check. Help with shopping, check.
    But hang on a minute.
    He is surrounded by neighbours who love and care for him. One already brings him Sunday dinner every week, another would do his shopping for him, another might cut the grass now and again. Yet ‘the system’ by default overlooks these neighbourhood resources in favour of contracting with a third sector care provider.
    What if, instead of holding a case conference with professional service providers we held a case conference with local neighbours and asked if they would be prepared to help, and THEN we went to the state to fill remaining gaps?
    We might actually be able to develop a complex web of relationships around him that might be akin to a strong community, caring for their own, and save the tax payer a few bob along the way….