As lockdown restrictions ease and the NHS looks to restart routine care, community health services are preparing for the next phase of the pandemic with a clear will both to lock in those transformations which are working well, and to phase back in essential services where capacity is available. Andrew Ridley, chair of the Community Network and also the chief executive of Central London Community Healthcare Trust looks back on the community sector’s contribution and achievements thus far and offers some reflections on how we best prepare for the next phase of the pandemic.
Looking back on Phase One: Preparation
Community services played a leading role in the NHS’ preparations for the peak of the outbreak in April, without which the health service simply could not have coped. Community services supported thousands of discharged patients and freed up much-needed hospital beds.
Community providers have also been working hand in glove with the social care sector, including supporting care homes with protective equipment, staff shortages and training on key areas like infection prevention and control. In some respects, this has been the acid test of successful collaboration across health and care.
Transformation under pressure
There is much to celebrate in the community sector’s response to COVID-19.
Several community-specific elements of the NHS Long Term Plan have been accelerated by the pandemic. Community services adapted discharge processes in days (in some areas this had been an ambition for years) and are now caring for more patients with higher acuity and more complex needs than ever before. Embedding this model after the crisis response period will be key, but we’ll need to work out the legislative framework and pooled funding arrangements to ensure its success.
There has also been a rapid move to telephone and video consultations where appropriate, particularly for care homes, as well as additional support for high risk individuals shielding at home, in collaboration with primary care. In fact, the digital transformation and integration with primary care we have long needed has in many areas been accelerated by our response to the pandemic.
Of course, like everyone in health and care, community services have had to flex, but our colleagues have done so astoundingly. Following national prioritisation guidance, some services were stopped or partially stopped so that staff could be re-deployed, with appropriate training, to more urgent tasks. This provided welcome flexibility and released capacity to enable the discharge to assess model.
We are confident we do have the capacity and the abilities to adapt, and not just in the short term.
Of course there have been significant challenges. Distribution of personal protective equipment – especially to the 50,000+ health and care organisations outside of the main NHS trust supply chain – continues to be challenging, as does access to regular testing for all NHS and social care staff which would enable effective infection prevention and control.
We must also recognise this is a time of great intensity and stress for our workforce – it is important we have the tools to look after them both now and in the future.
There is evidently a need for much greater infrastructure and support for care home residents and staff. Community services, alongside colleagues in primary care, are building on existing good local relationships and delivering a pared back ‘enhanced health in care homes’ package recently brought forward from October to May.
Implementing Phase Two: Recovery
As the NHS implements the second phase of COVID-19 response, the community sector is bracing itself for an even bigger surge of demand. It’s true that in some areas this has put a strain on capacity. However, our experience is not that community services will ‘bow’ under the pressure, but adapt, innovate and transform.
We will see increased demand for community health services for the foreseeable future as:
- more COVID-19 patients are discharged from hospital and need ongoing support;
- at the same time as elective care is reintroduced and non-COVID-19 patients need community rehabilitation;
- pent up demand for services will be released as lockdown restrictions ease;
- essential community services start being phased back in where local capacity is available; and
- care homes and shielded patients will need ongoing physical and mental health support.
Increased capacity and investment in community services will be necessary to embed these changes and maintain flexibility in case COVID-19 spikes again, as referenced in the Government’s recovery plan on 10 May.
So, when we think about restarting community services that were deprioritised initially, it’s helpful that the first half of the restoration of community services guidance (published on 3 June) encourages providers to make local decisions about what needs to be brought back on stream when. The tone of the 29 April letter from NHS England and Improvement was helpful in this regard, and reflected feedback from the Community Network and others. This locally determined, phased approach must be driven by system-wide demand and capacity planning before we turn the tap on elective care.
Everyone across the NHS will be keen to make sure we lock in the good innovation and reset to a ‘new normal’ effectively, including embedding the rapid discharge to assess model, increased use of technology and renewed impetus to work together with primary and social care colleagues to support our most vulnerable. As a Community Network, we are supporting NHS England and Improvement to understand the transformative benefits this crisis has accelerated – as well as the difficulties – and to hang on to those new and beneficial ways of working of our staff, and our patients, for the longer term.