The way we talk about healthcare needs revising. The way healthcare works for us needs revising. NHS Providers (“the voice of NHS public provider trusts”) has recently published a call to action for the transformation of community health services: Community Health Services – A Way of Life.* It comes as the public interest and fervour for transformed services is significant; new models of care and service-delivery are much needed and wanted.
The call to action focuses on community health services (out of hospital care in neighbourhoods and homes), as an area that is most misunderstood and undefined. In contrast with news relating to acute care services (hospitals, A&E etc.), community health services have a smaller propensity to capture the national attention; national statistics on waiting times, policy agenda changes on performance and sustainability for example are much more readily covered by press and the media. NHS Providers identify that, therefore, the potential of community health services to provide the sustainable core of the NHS can be under-recognised – community services should be thought of as central to driving new models of care.
The importance of language here should not be underestimated. We are all too used to hearing about interventions – primary hospital care, emergency services etc. – an idiolect that is maintained by NHS funding and performance measures geared towards waiting times and response times. Consequently it is sometimes difficult to identify the value added by community health services.
The difference is that primary care interventions and emergency services deal with patients who identify as patients; they seek specific care, and have specific needs. As such, they are treated in care institutions designed specifically for these patients. In contrast, community services support people in their homes and neighbourhoods who need care. This is so far removed from the type of care provided by institutions such as hospitals that the term patient hardly applies.
The real world impact of community services spans far beyond specific and timely treatment of specific health needs such as in a hospital. For example, the support of a health visitor will have a preventative effect on the health of a person for decades, and nurses in people’s homes can contribute to better health standards for people for years. Care delivered in people’s homes and neighbourhoods moves away from the kind of dependency fostered by immediate reactionary care. It is a move towards self-sufficiency, self-awareness and self-care.
These three key indicators (self-sufficiency, self-awareness and self-care) are key indicators of care moving away from a dependency on primary care interventions, and we are well-placed now to facilitate this transition. The growing range of seamless devices to monitor health and care and promote self-awareness provide more and more new opportunities to aid preventative care. Crucially, it puts people in control of their healthcare whilst also reducing costs.
Transitions, however, take time. For the health and social care sector to facilitate this change, the NHS universe needs to see people not patients as its mission. As opposed to organisational structures and processes, the system should be moulded around people and their needs. When there is talk of integration, integration must be thought of as an outcome benefit experienced by the person, rather than simply an organisational form or administrative exercise.
This will require a transformed, sensitive approach to evaluating feedback from service-users; if care is to be delivered in home then how will the appropriate application of this care be regulated? The workforce must become highly skilled in listening; engaging; interacting with people if their care is to be handled in their own home, as the relationship dynamics are very different in this setting to that of a hospital for example. This calls for an intimate approach to service redesign: the NHS must be invited to be guests in the everyday lives of people rather than the go-to place when something goes wrong. Only then will the dependency on immediate, primary care be shifted towards a self-aware, sustainable approach to achieving health outcomes.
NHS Providers, Community Services – A Way of Life, NHS Providers, 2015