Neighbourhood health hubs at risk as community care under strain

The government’s goal of moving care from hospitals into neighbourhood health hubs is at risk because community services are under too much strain, the health and care regulator says.

In its annual report, the Care Quality Commission said waiting times were too long and staffing too stretched in areas such as mental health, GP care and social care.

The regulator said there was a real risk patients would suffer because these services would not able to cope with the extra demands.

But the government said investment was being made to address the pressures.

The 10-year NHS plan published in July set out a vision for a neighbourhood health service through the creation of clinics integrating different elements of GP care and hospital services with wider community support.

Such a system is seen as crucial way of coping with the ageing population and growing numbers with long-term conditions such as heart disease, diabetes and dementia.

The CQC used its own inspection reports and published data to draw up its annual analysis.

It raised a number of concerns about the current state of community services, including:

• Long waits for mental health – with a third of adult patients reporting wiats of three months or more between first assessment and treatment, plus signs that waits for children are even worse
• Continued problems accessing GP services – with only half of patients finding it easy to get through on the phone
• A dramatic drop in district nurse numbers – with 50% fewer per person over 65 than there was 14 years ago
• The struggle to get state-funded social care – with the proportion of older people getting help from councils dropping to 3.6%, compared to over 8% 20 years ago

CQC interim chief executive Dr Arun Chopra said: “The 10-year plan is a real chance to improve care by putting people’s needs first. But for the plan to succeed, community health and care services need more support.”

“Without this, there’s a risk fewer people will be able to access good care, with vulnerable groups hit hardest.”

He said older people, those with dementia, learning disabilities and complex mental health needs were most at risk as he called for more investment in services outside of hospital.

The report also included patient stories. In one, Arjun set out his experience trying to get support for depression and anxiety.

He did not want to take medication and it took him six months to convince his GP to put him forward for talking therapy. He then faced a further nine-month wait for treatment.

His mental health got worse and he started having suicidal thoughts.

Warnings were also made about hospital care, with the CQC saying there were ongoing concerns about staffing in maternity units in particular.

But it said there were some excellent examples of good practice and innovation too.

It highlighted a scheme in Haringey, north London, where GPs, community services, hospital staff and social workers had come together to identify and support local people with complex health conditions.

By providing extra tailored support, it managed to reduced emergency attendances and admissions in this group by 30%.

A Department of Health and Social Care spokeswoman said: “This report lays bare the scale of the challenge we inherited after years of neglect and underfunding.”

But she said the government was getting the NHS “back on its feet”, with extra investment beginning to help recruit more staff to key areas, such as GP services and mental health.

“We know there is much more to do – we are working at pace to fundamentally reform services through our 10-year plan to build an NHS fit for the future,” she added.

But Dr Hugh Alderwick, of the Health Foundation, said the CQC was right to raise concerns.

“Over a year into the new Labour government, health and care services are still under massive strain.”

He said the think-tank’s own analysis suggested the government was still far from having a coherent policy agenda to make their promises a reality.

“A more concrete plan is now needed – including for rapidly testing and evaluating innovations that could improve local services.”