UK Government

Department of Health (National): Plans in place to transform Community Services

Press Release   •   Nov 26, 2010 11:26 GMT

NHS staff across England are taking control of the community services they deliver in a drive to improve outcomes for patients and transform patient care, the Department of Health announced today.

From April next year, all Primary Care Trusts should have separated the commissioning of community services from their provision. All staff and services will be transferred to a range of new organisations such as aspirant Community Foundation Trusts and Social Enterprises, or integrate with existing providers. This is part of the Transforming Community Services programme which will deliver more personalised care closer to home.

Community services provide essential care to many people in vulnerable circumstances, families and communities, from health promotion to end of life care. The service is an integral part of the local NHS, employing around 200,000 staff and representing around £10bn of NHS spend.

The new organisations will provide more choice for patients and have a vital role in the transfer of care and treatment from hospital settings to help patients with their recovery or manage their healthcare needs. The organisations will support the NHS in its drive to improve quality and productivity, by encouraging clinicians to innovate to transform services, promote healthy lifestyles and focus on prevention.

Implementation of these plans will require real change management expertise, clinical engagement and patient input, to ensure completion of transfers prior to the end of March.

26 per cent of the value of community services currently provided by PCTs will, in the future, be provided by Community Foundation Trusts, and a further 10 per cent by Social Enterprises. Both of these innovative models have a strong emphasis on community involvement so that they are truly accountable to patients and led by local decisions.

Community Foundation Trusts will be financially more independent but still part of the NHS family. Eight have already become NHS Trusts and are on their way to gaining Community Foundation Trusts status, with up to another eight to follow.

Community services will also be provided by integrating community services with acute or mental health services. Both of these models have their benefits in providing patients with joined up care or forging strong local authority partnerships.

Simon Burns, Minister of State for Health said:

"The proposals we set out in the White Paper aim to put patients at the heart of the NHS, giving them more choice and better control over their care. These changes to community services will enable clinicans to deliver personalised and responsive care and better outcomes for some of the most vulnerable in our society.

"Frontline staff will be in the driving seat to improve quality and integrate services to ensure the most effective outcomes for their patients. And there will be further benefits - frontline staff are best placed to provide the most efficient services so that local NHS money goes further.

"Plans are in place for Social Enterprises to provide almost £900m of services a year a major step towards our ambition to create the largest and most vibrant social enterprise sector in the world."

The staff-led social enterprises will be set up under the Right to Request scheme where over 25,000 NHS staff are expected to transfer to these new local organisations. Three are already up and running - in Hull, Kingston & Leicester.

Ian Dalton, DH Managing Director of Provider Development and Chief Executive of North East SHA, said:

"These plans provide firm foundations for transforming these key services and speeding up the transfer of services out of hospitals and in to local communities and people's homes.

"The range of options chosen - including 16 aspirant Community Foundation Trusts and over 60 Right to Request social enterprises - shows the enthusiasm of local NHS staff for taking control of improving services for patients. These are potential 'hot-beds' of innovation and community engagement - but this is only the beginning. The hard work starts now as boards sign off business transactions and plans are completed, and the NHS gets underway with setting up new organisations. They will be able to empower staff to lead change and transform services and working practices."



1. The range of future providers broken down by budget value as at 25 Nov 2010 is as follows:

To view the pie chart that accompanies this release, please follow the link below;

2. The NHS currently spends around £10 billion a year on services provided within the community, of which £8.5 billion (as represented by the pie chart above) is currently directly provided by primary care trusts. It is these services that PCTs are working to divest themselves of.

3. As at 25 November, 98 per cent of these have either already transferred or have been agreed by the Department and are moving towards their final form by April 2011. We expect to agree the remaining three approved in December 2010.

4. Following DH approval proposals are subject to final SHA assurances and where significant transactions involving Foundation Trusts are proposed, Monitor (the independent regulator for FTs) will undertake an assessment of the transaction prior to FT Boards taking on community services.

5. For media enquires please contact the Department of Health Press Office on 0207 210 5221.


Social Enterprise

Sir Ian Carruthers, OBE, Chief Executive of NHS South West
"Social Enterprises provide an effective organisational form to involve staff and place them at the centre of delivering improved patient care, as well as increasing their influence in the way their organisations operate.
"In our view the drive and ambition of NHS staff must be appropriately encouraged so that we can continue to improve and deliver the highest quality of service to patients in the most appropriate settings."

Live social enterprises

Inclusion Healthcare, Leicester
Inclusion Healthcare (formerly known as Leicester Homeless Healthcare Service) operates as a multi-agency one-stop-shop for homeless people. Offering a GP service, drop in centre, outreach and night shelter, Inclusion Healthcare offers its clients a range of services. Visiting agencies also provide classes in numeracy and literacy skills for working life, plus computer training, art and home economics sessions.
In 2009, Inclusion Healthcare carried out 9,301 consultations and extended its services to 1,075 patients. Their business case was approved by the PCT and SHA earlier in the year and they went live as a social enterprise in September 2010. They have also accessed funding from the Department's Social Enterprise Investment Fund. Their business name, Inclusion Healthcare, reflects both their holistic approach to meeting clients' needs and their engagement with a wide array of local partner agencies.

Jane Gray, Nurse Consultant:
"The benefits for us are about being able to respond to patient needs in real time and to develop services without having to gain fresh approval. It's about having the authority to act... We deliver on the front line and see the need and we don't want to be stopped by red tape."
"[Social enterprise] is a win-win for... the vulnerable people that we serve, but it also makes sense if you're looking at quality care and if you're looking at value for money as well."

Anna Hiley, GP:
"We are frontline clinicians delivering primary care to a group of people who are not well served by mainstream practice. We see the gaps in service, we want to be able to innovate and respond to that need flexibly and in real time, and we're hoping that that's what we'll be able to do as a social enterprise."

City Health Care Partnership, Hull
City Health Care Partnership CIC (CHCP CIC) is an independent, not-for-profit social enterprise providing NHS services to the residents of Hull.

CHCP CIC, previously NHS Hull provider services, officially formed on 1 June 2010 as an independent health services provider separate to the commissioning organisation, NHS Hull. It was the first social enterprise to go live as a result of the Right to Request scheme. 
They provide a wide range of services to over half a million local people - approximately 250,000 resident in Hull and a further 325,000 who live in the surrounding East Riding of Yorkshire. Core services include primary health care, specialist health care, and children and adult services. 
Their turnover is £50m and they have 1500 staff. Their mission is: 
* To grow a socially responsible profitable business that contributes to the wider well being of the communities in which we provide services. 
* From which the high quality and safe services delivered are personally responsive, caring and inclusive of all. 
* And where people love to work. 

Andrew Burnell, Chief Executive of City Health Care Partnership: 
"This model, when we looked at it, became extremely exciting as a way and a means of doing things different, and actually engaging clinicians. But also allowing staff to have some share and some ownership in what they do. And some of the evidence behind some of that was really quite compelling as a model."

Community Foundation Trust

Cambridgeshire Community Services NHS Trust

Cambridgeshire Community Services NHS Trust (CCS NHST) became the first community NHS Trust on 1 April 2010 (so already separated from local PCT). 
CCS NHST plans to undertake a formal public consultation in Jan - March 2011 as part of its application for NHS Foundation Trust status. 
Examples of how it is improving services already 
CCS NHST has introduced a Re-ablement Service in partnership with their local authority, to improve the independence and quality of life for many of their patients, as well as reducing inappropriate hospital admissions. (Re-ablement is a short term free service aimed at providing support to individuals wanting to regain independence following a spell of ill health or a hospital episode) 
CCS NHST is working with the hospitals to provide more services in the community or directly in peoples homes, including diabetes care, musculo-skeletal services and minor oral surgery. Results to date include easier access for patients, more choice, reduced waiting times as well as savings to local health economy. Plans are underway to shift podiatric surgery and sexual health services to community locations. 
Future plans include: 
* Improving health and social care services for children and adults, supporting people living with long term conditions (e.g. diabetes) through self-management programmes 
* Expanding use of telecare/ telemedicine, including leading edge technology that enables remote monitoring and a speedy response to fluctuations in patient's vital signs 
* Specialist palliative care services: providing end of life care and therapies in the home setting and ensuring people have choice about treatment at the end of their life and the place of their death. (The National End of Life Care Intelligence Network's report 'Variations in Place of Death in England' ranked Cambridgeshire in the top 5 nationally, in terms of supporting people to die in their place of choice. Our services are central to this achievement ).
* Health visiting services: transformation programme underway moving away from a target-focussed service to one that supports families give children the very best start in life

CCS NHST is also embarking on a programme of work to establish itself as a University Trust, focussing on research, education and teaching to improve quality of care and outcomes for local people.

Integration with Mental Health Trust

Coventry and Warwickshire Partnership NHS Trust

The organisational vision is for the full integration of community services. This is supported by integrated care pathways, and underpinned by local protocols for joint working. Together, these ensure that patients needs and choices remain central when delivering safe, efficient and high quality services to the local population.

Josie Spencer, Managing Director, Coventry Community Health Services:
"We have a great opportunity to join up local services to make improvements for local people. Many of our patients and their families currently receive separate services from the two organisations. For example, patients with long term conditions also have some level of mental health need. In end of life care we could greatly improve services to patients and their families if there was better access to psychological services. For children's services, better integration with mental health services will greatly improve both the young person's experience and lead to a more efficient mode of care being offered. We believe this is a big opportunity for the people of Coventry."

Integration with acute provider

Buckinghamshire Healthcare NHS Trust

Transfer of PCT Community Services has taken place, an establishment order has been enacted, and service responsibility has been officially passed to the Trust.

The acquiring Trust has developed an integrated organisational structure, providing increased rigour to the management of community services and ensuring that acute services are more outward looking (including a GP as Divisional chair for community and integrated care who sits on Trust Management Committee)

The Trust has been able to effect change across the boundaries, for example:
* Increased utilisation of community hospitals
* Community IV service already up and running - reducing acute LOS and acute admissions
* New Chronic Obstructive Pulmonary Disease pathway - integrated from primary care through to secondary care launched 1/11/10

There has also been a reduction in management overheads - with a corporate review undertaken removing at least 10% of cost. Increased clinical governance of community services has been a further benefit.