Adults' community health services

“I am proud and honoured to still be a part of the NHS. I believe my work ... is making a tangible difference to people's lives, has reduced the risk of future preventable diseases for hundreds of clients over the years. I believe this focus on health inequalities and person-centred preventative care is also helping to reduce the burden on acute services and primary care.”

(staff survey response)

This report is a summary of the key findings from the engagement on adults’ community health services which took place in the summer of 2024. It outlines findings from:

• A patient/public survey (adults)
• A staff survey
• Four in-person listening events and two online listening events
• The findings of nine community organisations working with underserved and less- listened-to communities
• Seven interviews with housebound patients.

An appendix accompanies the report setting out the findings from each engagement activity in more detail. A further report details the findings on children’s community health services.

Key messages

A number of themes re-occurred throughout the engagement activity. These should be built into the next stages of planning for community health services.

Staff are highly valued by patients and communities for their caring dedication to patients and families.

Staff themselves feel they make a difference to people and that they are well placed to understand needs and to work flexibly to deliver care. However, there are issues with capacity - having enough time to do a good job and having to spend too much time on administrative tasks. A comprehensive plan to develop a sustainable workforce for the future is required.

Communications with patients must be improved. People need open, regular communications and a clear way of getting in touch with services. This includes:

• improved phone lines
• better translation services
• accessible formats
• clarity around who is responsible for what and what will happen next.

Honesty about waiting times was a requirement from many of the patients and families.

Involving people in decisions about their care and listening to patients and families was seen as a priority by both staff, patients and members of the public responding to community organisations. The role of unpaid carers needs more recognition and more systematic support.

Staff mostly do not feel they are well joined up with different organisations. Joined up care which focuses on improved patient outcomes and experience could be achieved by focusing commissioning on patient outcomes, by stressing better communication between teams, by rolling out multidisciplinary team and integrated neighbourhood teams. There should also be seamless sharing of patient information between health and care providers including hospitals and social care.

Focusing resource on preventing ill health and local partnership working is needed which includes shifting resource into community services and into community prevention work. This will help the system with ever growing demand and improve health and wellbeing in the longer term. There must be recognition of all the local partners who can achieve this, including voluntary and community sector organisations, and local communities.

Reducing waiting times and making sure services are equitable across Kent and Medway were also seen as key to improving health particularly in areas where there are higher levels of deprivation and poorer health.

What did people tell us?

Surveys

135 people completed the patient and public survey and 120 completed the staff survey.

The adult community health services most frequently used by respondents are musculoskeletal services (MSK) (43 per cent), community nursing including specialist and complex nursing services (27 per cent), continence care and continence management services (25 per cent), urgent community response (24 per cent), and health and care co-ordinators (21 per cent). We heard from clinical and non-clinical staff from all the current community health care provider organisations and from those working in other related bodies such as acute hospital trusts.

Overall experience of patients is good with 42 per cent rating the services as ‘good’ or ‘very good’ and 17 per cent rating them as ‘excellent’. The main reason for the positive responses were the quality of care and the caring nature of staff:

“Everyone we dealt with from staff booking appointments, physios, the community rehab team and nurses were all really helpful.”

Staff told us the main things they value about working in or with community services are making a difference to patients and families through providing flexible, patient centred care. They also valued being able to provide care in people’s homes and close to people’s homes, and the colleagues in the teams they work with.

Patients and the public told us the main areas for improvement were communications and the provision of information including better phone access, more clarity about appointments and how long they would have to wait. Participants also asked for shorter waiting times.

Staff told us that the following would improve services:

• Better sharing of records and data across health and care services
• Improved communication across services
• Increased funding and staffing
• Reduced waiting times
• Improving the equality of access across different geographical areas
• A multidisciplinary approach to care.

What matters most?

Survey respondents were asked to rank ten key priorities for improving services. Staff and patients mostly agreed on what was most important for people who use services.

Being able to get to services was also important to patients and the public – with some people telling us that they struggled to get to appointments due to the location of services and poor public transport links. However, when asked, 46per cent said it had been easy to travel to their last appointment.

Listening events

Listening events were held in East Malling, Chatham, Dartford and Canterbury and a further two were held online. The events were attended by 83 participants including health and care staff (clinical and non-clinical) and representatives of health and care partnerships, patients and family carers, and community and voluntary sector organisations. Participants discussed what is currently working well and what could be improved. People told us this improvement programme needs to make sure a shift in resource towards community health services and to preventing ill health. Future models of care should emphasise collaborative working and breaking down unnecessary barriers between organisations.

The improvement must focus on:

• Building on and supporting current good practice – including how community health service staff are embedded in the community, and tools for providing more self-care and support, and use of new technology
• Improving access to services and reducing inequality of access – with concerns raised about a ‘postcode lottery’ contributing to health inequalities in the least affluent areas of Kent and Medway
• Focus on prevention of ill health – drawing funding and focus into partnership approaches to reducing health inequalities and supporting health and care partnerships in their approach to working as widely as possible with partners to deliver healthier communities
• Supporting and respecting staff and building workforce for the future – focusing on sustainability and flexibility to support the delivery of care including support for high quality administrative support
• Better communications with patients and improving communications between different providers and teams – some patients experience periods of silence when they are waiting for appointments, staff report problems with ‘hand-offs’ and transition points for patients to different services
• Embedding multidisciplinary team working making sure that the focus is outcomes for patients and moving away from organisational boundaries– also reducing the number of ‘single points of access’
• Integrating services into local neighbourhoods – incentivising collaboration will encourage better working with community and voluntary sector organisations place value on partnership led initiatives which work across sectors
• Better sharing of patient information - making sure that each professional involved in a patient's care journey is well-informed, reducing the likelihood of errors, duplications or miscommunication
• A systematic approach to recognising and supporting unpaid carers – helping people stay well and maintaining their independence through a unified approach to supporting family carers across the system

While there was a great deal of passion and commitment to local community health care and participants came with good examples of patient focused integrated care. People also told us they had participated in similar discussions in the past and had heard promises of change before. People wanted to see evidence of change and the differences their input had made.

Community organisations: Gathering views from underserved communities

“Everyone is different with different capacity and needs – person centred care. You have a learning disability nurse – but not one for physical disability – I think is totally wrong.” (respondent, Disability Assist)

Community based organisations Disability Assist, Diversity House, Folkestone Nepalese Community, Hi Kent, Involve Kent, Kent Association for the Blind and Social Enterprise Kent conducted interviews and ran discussion groups with people living in areas of deprivation, people from minority ethnic communities and people living with disabilities and long term conditions.

People told us they had mostly good experiences of community healthcare because of the dedicated, professional and caring staff. Improvements could be achieved through having more joined up services, better staff awareness around the different individual needs of patients, staff having more time to be able to provide person centred care, better record sharing and better communications around what to expect. Key themes in the discussions and interviews were:

• Help and support when using multiple services – many respondents needed to use several services and found it difficult to understand the differences between different services. Services need to be joined up around the person
• Provision of easy-to-understand communications – provided in a variety of formats and translated into different languages including information about where I am on a waiting list and explaining referrals
• Being listened to and taking part in decisions about their care and support was very important to people – this was the number one priority when people were asked to rank key priority statements
• Person centred care is important – teams need to understand and appreciate different needs and preferences and be facilitated to respond to these to help people stay happy and independent
• Involvement of family carers and close family members is also important
• Flexibility around appointments including longer times where required and more access to face-to-face appointments in their local neighbourhood when needed
• Travelling to services was a particular concern for the participants located in some areas such as Swale and for people with some disabilities which made travelling more problematic – locating services near to where people live is important and making appointments easy to get to

Interviews with housebound patients

“I know them so well now they are like part of my family…and that’s great” (patient interviewee)

Seven housebound patients who receive community health services were interviewed. They were extremely satisfied with the care they received. Many had built relationships particularly with community nursing staff and told us that developing personal relationships contributed to the high quality of care they got.

Being treated with respect, understanding what is going to happen and having a number to call were all highly valued. Improvements could be made to how information is communicated, giving staff more time with patients, co-ordinating care at home across the system and involving patients and families in decisions.

Thank you for your involvement!