Q members reflect on the NHS 10-Year Health Plan for England: David Seamark

The NHS 10-Year Health Plan for England has laid out ambitions for three shifts: from care delivered in hospitals to in communities, from a focus on treatment to prevention and from analogue to digital.

In the spirit of collaboration and learning, we asked members to share what they found exciting about the plan, what is missing and where they think improvement approaches can play a role. 

For the next week, we will be sharing reflections from members across England on the plan and the culture and conditions needed for its implementation. Our diverse community of people working to improve health and care is uniquely placed to make a real difference to the success of its implementation. These reflections can help us all take stock of where we are and think together about how to get where we need to go.

The Community Hospitals Association (CHA) welcomes the initiatives described in the 10-year plan, with more health care and disease prevention to be delivered in the community, closer to where people live.

Community hospitals exist in a variety of configurations. In essence, they are community hubs providing a very wide range of services, including some with inpatient facilities. England’s 346 community hospitals are ideally placed to act as the community hubs described in the plan. These hospitals and community hubs, serving mainly rural and semi-rural populations, have a history of adaptation and flexibility and already act as multidisciplinary health providers for the communities in which they are embedded. 

Community hospitals are deeply engaged with the surrounding community, providing minor injuries services, health promotion, diagnostic services, outpatient clinics, rehabilitation services and frequently inpatient services near to patients’ homes. Community hospitals are often the base for community nursing, rapid response teams, palliative care teams and mental health services. Primary care providers are often co-located with community hospitals, and GPs provide inpatient care and out of hours services.

Staff enjoy and value working in community hospitals, which aids recruitment and retention. An Innovations and Best Practice Awards scheme run by the CHA demonstrates the desire and capacity of community hospital staff for quality improvement. The response of staff and management to the COVID-19 pandemic illustrates their flexibility and ability to adapt at pace to challenging conditions.

Community hospitals act as a bridge between acute hospital services and the community. Step-down services are provided for patients after acute illness or major surgery, allowing for secure rehabilitation and planned discharge, usually to the patient’s home. This relieves pressure on acute sector beds. Some community hospitals offer acute assessment and treatment services, again alleviating pressure on the acute hospital. Locating outpatient clinics in community hospitals is popular with patients and clinicians as they can receive care nearer to home in familiar surroundings, reducing transport miles and stress.

Community hospitals are natural digital-inclusion hubs, as demonstrated by the use of NHS 111 direct booking services into minor injury units and emergency medical assessment units, point of care diagnostics and virtual ward follow-up.

The geographic spread of community hospitals, their deep links with the communities they service and their ability to rapidly adapt provide the government a ready-made framework for implementation of the 10-year plan.