Transforming, elevating, and improving NHS community services requires an evidence-base built on the foundation of high-quality data. Chris Giles explains how community trusts and integrated care boards can use it to improve productivity and transform clinical services.
In his first speech to the Labour Party Conference as Secretary of State for Health and Social Care, Wes Streeting said that the Government’s planned reforms to the NHS would result in three important shifts:
Community services play an integral role in all three of these deliverables. The Government’s ‘Change NHS’ consultation follows the publication of Lord Darzi’s review of the state of the NHS in July 2024, which called for a greater focus upon ‘integrated, patient-centered, and technology-driven community care,’ stressing the importance of prevention and early intervention in community settings to reduce the burden on hospitals.
Strengthening integrated care boards (ICBs) and expanding community providers, who are in many instances partnering with acute services, do have the potential to deliver on the government’s aspirations. To do this, community services require well-managed high-quality data to inform decision making and care delivery. NHS England’s plans to introduce currencies for community services will necessitate better and will be more reliable data to inform funding, but there are unique challenges that need to be properly understood and addressed before the value of community data it can be realised.
The quality, relevance, and availability of data has always been a challenge for community services. Working in silos and a block-funding mechanism that doesn’t incentivise the need to understand granular activities is compounded by the shifting of community contracts between providers struggling to implement standards across an organisation. Many community trusts have developed ways of working and capturing information and data that don’t align either with their peers or national standards, such as the community services data set (CSDS). In many cases different parts of the same provider will adopt different standards or ways of working that make data incoherent or incomparable.
Community data is often inconsistent, with the local configuration of clinical systems allowing these problems to be perpetuated. This leads to challenges in measuring activity, patient outcomes, and productivity alongside soft metrics, such as workforce wellbeing, resulting in investment cases or savings plans that don’t have an evidence base. The historic reporting asks from commissioners have added to the inconsistency rarely aligning to one another or national counting rules. This is compounded in ICBs where funding is being more centralised, and as other providers vie for the same resources and financial pot they’re rightfully questioning where investment should be prioritised.
Block contracts which haven’t been updated to reflect changes in demand post-COVID-19 haven’t supported the necessary mindset to truly understand the value of community services and their future potential. NHS England are publishing new currencies for use in 2025/26, signaling a move to a more standardised approach to using data to inform funding for community care, and if latest reports are to be believed, the Government is favouring a return to competition and choice to drive up standards.
The financial incentive provided by Payment by Results (PbR) drove improvements in acute data in the decade preceding COVID-19. However, the need for high-quality data extends far beyond financial motivations, as illustrated in the graphic below. Delivering the 10-year plan will require a better understanding of community services at the national, regional, and local level. Good quality data puts the patient at the centre of decision making.
Good quality data puts the patient at the centre of decision making
| National drivers | |||
|---|---|---|---|
|
Payment Scheme
|
10-year plan
|
New performance targets
|
National collections (CSDS / PLICS)
|
| ICS drivers | |||
|---|---|---|---|
|
Identify efficiencies and opportunities
|
Like-for-like comparisons
|
Understand needs and outcomes
|
Facilitate clinical consistency
|
| Local drivers | |||
|---|---|---|---|
|
Evidence-based decision making
|
Assurance to board
|
Access to relevant reporting
|
Increased data literacy
|
| Patient level drivers | |||
|---|---|---|---|
|
Safe care
|
Integrated care
|
Effective care
|
Improved outcomes
|
This challenge won’t be addressed by investing in new systems or strategies where capital isn’t available and developing technological solutions that saddle providers with new revenue commitments. Trusts need to make best use of existing infrastructure and systems, and optimise what’s already there.
Supporting clinical teams’ understanding and use of data will result in an improvement in data quality, and an understanding of the improvements necessary so that systems, hardware, and infrastructure are can better support the delivery of patient care.
The benefits of data need to be firmly championed so that it’s embedded into team meetings and daily operational discussions, not something that’s kept at arm’s length and wheeled out once a month to validate or challenge. Adding value to data within the clinical teams allows them to understand variation in care or changes in their local referral demography, and starts a cycle that then improves its quality and availability to clinical teams. This foundation can then be used to underpin and provide evidence in resolving service challenges, and rightfully quantify value and benchmark outcomes or productivity both internally and with external peers. There’s evidence of significant variation between providers and even between boroughs within a provider, where the percentage of time community nurses spent on direct clinical care varied between 18%-69% across the teams.
To support their clinical teams, trusts need to ask if their systems are optimised and structured to make life easier for them and make data-capture a byproduct of their decision making. Are systems designed to create structured data using simple forms or codified fields rather than lengthy narrative or journal information which make reporting impossible? One example is using a standardised wound-care template that consistently captures pertinent information, supports improved management, and returns data that can be used for improving patient experience and provides clinical improvement opportunities.
Structured simple forms with defined clinical entries supports ease of use and standardisation that yields consistent data aligned to accurate reporting definitions. There are scenarios where nurses have had options to record over 280 different referral sources, many of which were irrelevant, incorrectly spelt, or not adhering to the data dictionary. These systems need to be owned by the clinical community so success can be delivered by strong clinical information teams who are integrated into the service.
Community services by their nature depend on the mobility of their workforces and are disproportionately impacted by IT hardware and infrastructure challenges. Cumbersome laptops with multiple logins and inconsistent access to wireless networks provided by other health or social care organisations can disengage the community-based workforce. Access to electronic clinical information and the use of systems needs to be accessible and intuitive. The use of mobile data networks alongside open and available wireless infrastructure, provided in collaboration with partners to ensure availability, offers resilience and easy access for the teams.
Tablets and handheld devices engage practitioners who see technology, particularly a laptop, as a barrier between them and their patient or client. This disenfranchises clinicians who end up completing records at the end of a long day, with nurses transcribing into digital systems from handwritten notes or memory.
Until we place more emphasis on the importance of community data, any planning for service improvements is unlikely to achieve the aspirations of the Government.
Joint forward plans are crucial for the NHS's capacity for long-term healthcare delivery and financial stability.
