Bev Fitzsimons: Supporting community providers to improve quality

bev_fitzsimonsIf you look at how the NHS is represented in the media, healthcare dramas tend to equal hospital dramas: Casualty, Holby City, even the marvellous Getting on. Community services often feature as slightly misty eyed nostalgia of district nurses and midwives on bicycles—a bit of a blast from the past.

Hospitals can sometimes be busy, confusing places, to be avoided unless absolutely necessary—especially by people who are already vulnerable, frightened, or confused. Care provided closer to (or in) people’s own homes is often preferable in many circumstances.

Today’s mantra is that coordinated care is better for people using health services, and will be better for the public purse too. Although no one would argue with the former, the jury is still out on the latter. Community services are a vital part of delivering coordinated care, and could be the answer to many of the health service’s woes in the future.

That’s why it is so surprising that community services feature so little in the public dialogue on healthcare quality. Targets in acute services are widely known: cancer waiting times, four hour waits in A&E, 18 week referral to treatment times. Where are the equivalents in community services? And what do we know about the quality of community services, given their importance in riding the wave of increasing demand and tighter purse strings?

In the King’s Fund’s new report, “Managing quality in community healthcare services,” we explore this further. We found that, in a number of ways, our hopes for community services are justified: there are numerous examples of innovation and creativity in the way in which providers are looking at quality.

But, linking back to my earlier blog on the challenges of using data to understand quality, we also found cause for concern. Community providers told us that they lacked robust, comparable indicators to help them judge and compare the quality of care. National datasets for community services are distinctly limited in what they can say about the care delivered in the community and in people’s homes.

When you consider that quality failures in the acute sector can slip by under the radar despite the plethora of measures, systems, and metrics, and the very public manner of care provided in hospital wards, the lack of information on quality in community services is a worrying blind spot.

While community services have not lacked policy attention in terms of successive structural reorganisations, they have missed out on support for quality management. The healthcare system is not doing its best to support community services in their quality improvement efforts, which are essential if they are to play their part in the future vision of care and support outside the walls of the hospital. At worst, there is a serious risk that poor or declining quality in the community could be missed.

It’s time that the healthcare system harnessed the creativity and innovation that exists in community health services—to support it to manage quality better.

Bev Fitzsimons is a fellow in health policy at the King’s Fund. She joined the King’s Fund in September 2009 and led the Patient and Family Centred Care programme. She has previously worked at the Audit Commission and the Healthcare Commission, as well as working with the Commission for Health Improvement.

Competing interests: None declared.

This blog first appeared on the King’s Fund website here