Community services – do they compare to what it says on the tin?
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
People may argue that services in the community must be developed to provide care appropriate to the needs of the population now and in the future, but how can this be done?
Bringing services and people together is not a new concept. However, integrating services around people’s needs and to support population health has been highlighted as ‘essential’ in the NHS five year forward view and in sustainability and transformation plans (STPs), through delivering care locally.
This remains challenging, and the ambition of true integration with increased demand for care and support, a growing and ageing population and addressing funding pressures raise further challenges. There are workforce shortages in key groups of the community such as in district nursing, where numbers have halved – presenting a significant challenge to plans to expand community services.
Moving forward, it is essential to make better use of the wide range of assets in the community and, at the same time, to break down silos between services and reduce fragmentation of service delivery. This requires consideration of voluntary and community sector organisations, private sector organisations, support groups, social networks, individuals, buildings and community spaces.
What do community health services provide and what services can we access?
The majority of community health services in the Birmingham South Central CCG area are provided by Birmingham Community Healthcare NHS Foundation Trust (BCHC), a large standalone NHS community trust. The trust also provides services to a much larger area, delivering NHS community health services to a population of 1.1 million across Birmingham and the surrounding areas, and specialist services to a population of 5.5 million across the West Midlands.
BCHC is one of the largest dedicated providers of NHS community services in England, delivering care from more than 335 sites (in addition to people’s homes). The trust has an annual turnover of around £260 million and employs more than 4,000 full-time equivalent staff. More than 2.1 million patient contacts took place in 2015/16.
Some community services are delivered by other providers – for example, sexual health services are delivered by one of the large acute trusts in the city in a variety of community locations, and community physiotherapy is also provided by the acute trust and the orthopaedic hospital. There are several hospices providing end-of- life care and many other voluntary and community sector organisations providing other forms of community support.
BCHC provides a wide range of services, organised under five divisions:
- The adults and community division: this covers most of the core community services for adults across Birmingham. Within this division, there are teams providing long-term condition management and community nursing, community therapy hubs, and a large number of specialist nursing and therapy services, for example for incontinence, tissue viability and lymphoedema.
- The urgent care division: this includes 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: this includes 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: this includes learning disability services – such as short breaks, psychology services, physiotherapy, occupational therapy and speech and language therapy – and rehabilitation services – such as inpatient neuro-rehabilitation, equipment services and specialist outpatient clinics.
- The dental division: dental services are delivered across hospital and community settings, and include maxillofacial surgery and other highly specialised work. The trust runs a specialist dental hospital. A crude count of services listed on the trust’s website amounts to 93 separate services. However, this does not give the full picture as some of these have multiple services or teams underneath, while in other cases a single team delivers several of the services listed.
There are 38 community nursing teams across the city, known as ‘integrated multidisciplinary teams’. The team members are mainly district and community nurses, assistant practitioners and other support staff. Most of the teams are based in health centres or large GP practices, and a small number are located in separate ‘hubs’. Specialist nurses (for example, specialist respiratory, continence and tissue viability nurses) are not embedded within the integrated multidisciplinary teams – they cover the entire city and the teams can call on their specialist expertise when required. There are several ‘therapy hubs’ across the city, where community physiotherapists and occupational therapists are based. Again, these therapists are not embedded within the integrated multidisciplinary teams
Finally, this is just what one community trust offers, there are many community trust that offer an abundance of services providing excellent quality patient-centred care.
But do we as clinicians know they are there? And do we know how to access them?
Is it our job to know what other services, support and care ares available for patients being discharged home or patients with complex needs, for example those who have had numerous falls or who can’t take their medication safely. I think that knowing his is part of all our jobs - integration is everyone’s business.