Comment / Community services: building on collaboration

The past six months have had a huge impact on us all, professionally and personally. In our response to Covid-19, we have had to learn quickly, be adaptable, strengthen our relationships with partners, while also dealing with the emotional impact of what is going on around us.

Like the rest of the public sector, community services providers have risen to the challenge. Very early in the pandemic, we received guidance around the services to prioritise, which allowed us to redeploy staff into our system priority areas. In particular, this helped to improve the flow of patients out of acute hospital beds and then to support them in their own homes. In my trust, it involved redeploying over 10% of the workforce, principally into sustaining our inpatient rehabilitation wards and our community teams.  

Through working with acute and social care colleagues, and applying the rules of the Supported Discharge Scheme, we have been able to support medically fit patients out of  acute hospitals, into the right pathways, freeing up thousands of beds across the country. As well as supporting these discharge pathways, our community teams have continued to visit vulnerable patients in their own homes, sometimes as their only visitors during lockdown, helping to keep patients safe and out of hospital.

But community services providers deliver more than just community nursing services and community hospital beds. During the pandemic we have had to be innovative in our search for digital solutions to support patients and maintain the care they required.

For example, in my trust, a new Chathealth texting service helped to support young people and parents. Our wound care clinics introduced more remote assessments and self-care coaching for patients. Our physio and MSK services adopted a virtual service model within days of national advice to stop face-to-face contact, which was extended to a new virtual model for delivering first contact practitioner services in collaboration with primary care networks.

And our community podiatry teams supported our local acute hospitals with the rapid expansion of shared care using the Silhouette 3-D imaging and information system, resulting in follow-up diabetes photos for treatments being delivered in the community to free-up capacity in the acute providers.

While we have been able to continue services for high-risk patients in most areas, we have built up backlogs of patients that need seeing. Some of our waiting times are hidden from the national oversight, but not hidden to the individual who cannot access care. As with the rest of the health sector, we have seen our productivity reduce as we have to follow essential infection control guidance, which has increased the average contact time.

The HFMA has just published a briefing exploring the role community services have played during the pandemic and will need to play in the restoration of wider NHS activity – The impact of Covid-19 on the future delivery of NHS community services.

As part of our recovery work, we have developed plans to reduce this backlog, but this will take time, and will need funding. Again, our services have looked at how they can reduce the backlog, and have come up with some further great ideas to do this and improve their throughput.

For example, our school-age immunisation service developed a drive-through service model for the delivery of HPV vaccine for year 8 to 9 girls and boys in the patients’ local areas. Our speech and language therapy service increased the number of assessments and follow-up calls through telephone and video consultations, which has also allowed them to provide support into care homes. And our pulmonary rehabilitation service now provides virtual patient group sessions, which support this vulnerable group of patients to get the care they need.

From a financial perspective, the trust has been fortunate in that our local authorities have followed the NHS in funding our contracts as blocks for this financial year. And they have taken a pragmatic view on what we can recover and by when. Our collaborative approach to managing resources has matured during the pandemic, and there has been a shift in mindset across the system around the need to understand the cost of provision across pathways rather than income.

Looking forward, the key learning from the past six months has been the importance of working together, with a shared aim and a shared commitment across health, social care and the wider public sector. The role of finance professionals is to support this partnership working. We need to create an environment to support innovation, develop a better and wider understanding of cost and unwarranted variation, and to remove the barriers to improve value for money and equality of outcomes for patients.

As we move into another difficult six months, the opportunity for us is how we use this learning to shape how we operate in the future in an emerging integrated care system (ICS). We need to develop financial flows to support this and make best use of the local health and social care system pound. I am sure, as finance professionals, this is a challenge we will rise to.

Chris Sands is a member of the HFMA Healthcare in the Community Special Interest Group. 

The impact of Covid-19 on the future delivery of NHS community services is available for download.