Making the most of our assets

Beverley Marriott is an Advanced Nurse Practitioner working in the Birmingham community healthcare foundation trust. She is also a King’s College Older Person Fellow. She tweets @bevbighair

The Reimagining community services report (Kings Fund 2018) highlights the need for strengthening community services with the aim of supporting our  older population, bringing to reality the vision set out in the NHS Five Year Forward View.

Unfortunately, the concept of reimaging services brings about concerns with growing financial and workforce pressures, these pressures could have a huge effect on the delivery of the recommendations. This could have a major impact on the ability of service providers to deliver services to meet the needs of the service user.

The Reimagining Community services report suggests that radical transformation of community services is required.  This would mean an additional share of the NHS budget. The NHS budget would be given to these services in order to make effective use of all the assets with our community. 

It is essential that we break down silos between services and reduce fragmentation in care delivery. This report focuses on improving population health as well as integrating care.

The report highlights the need for change, and highlights that the government and national NHS bodies should give attention to community services as they have given to acute hospital care over for many years.

Mapping community services is essential to reimagining community health services to identify how to deliver and organise community care.

A case study from Birmingham community healthcare foundation trust focuses on local services. Birmingham is an urban area and is one of the most diverse and deprived cites in England. Health outcomes and life expectancy are lower than the national average.

The majority of community health services in the Birmingham South Central CCG area are provided by Birmingham Community Healthcare NHS Foundation Trust (BCHC), one of the largest dedicated providers of NHS community services in England, delivering care from more than 335 sites.

The adults and community and urgent care division cover the core community services for adults across Birmingham including long-term conditions management and community nursing, community therapy hubs, and a large number of specialist nursing and therapy services, for example for incontinence, issue viability as well as intermediate care, palliative respite care, stepdown beds and a rapid-response district nursing service. A number of other services sit within this division, including prison health care, nutrition and dietetics and podiatry.

The children and families’ division provide  health visiting, school nursing, community paediatrics, children’s nursing and therapy services, child immunisation and specialist services for children with additional developmental needs. The specialist services division provides learning disability services – such as short breaks, psychology services, physiotherapy, occupational therapy and speech and language therapy – and rehabilitation on services – such as inpatient neuro-rehabilitation on, equipment services and specialist outpatient clinics. The dental division provides dental services that are delivered across hospital and community settings, and include maxillofacial surgery and other highly specialised work. The trust runs a specialist dental hospital.

BCHC have a number of incentives and have introduced a community medical assessment unit with geriatrician input. It is with the Black Country Partnership NHS Foundation Trust and the Dudley and Walsall Mental Health Partnership NHS Trust.

There are great changes happening that need to be sustained. It’s an exciting journey to be on knocking down silos and working closer together to meet the need of our patients. Transforming services in the community will require a commitment over many years, but where to start…

Read the King’s Fund report ‘Reimagining community services: making the most of our assets’