NHS at 75: why the workforce plan should start with communities

Building a community-powered NHS is urgently needed to overcome the current and future challenges facing the system. On the 75th anniversary of our much-loved health service, Laura Charlesworth delves into an innovative model of healthcare that puts community connection first.

As the NHS turns 75, we’re digesting the much-anticipated Long Term Workforce Plan. Alongside the three priority areas of Train, Retain and Reform, there are 90 references to community. From community pharmacy to community diagnostic hubs, there is clear emphasis on scaling up NHS care delivered in the community.

While these are steps in the right direction, what’s missing is scaling of NHS care with the community or better still, enabling healthy lives with the community.

While the plan acknowledges the importance of a more preventative approach and references the need for more flexible and generalist workforce to enable this, the role of communities in prevention and early intervention is overlooked, yet we know this works.

Earlier this year we launched a call for evidence for a forthcoming report on community centred approaches to health. Among the many brilliant examples shared were several initiatives championing the Community Connector model. Delivered by communities, for communities, this model focuses on what matters to a person, not what the matter is with them.

Recognising that people are best placed to make decisions about their own lives and that communities have assets that can enable positive change, this approach is gaining traction, from the well-established Local Area Coordination Network to smaller scale pilot projects.

Here are three powerful examples of place-based initiatives bridging the gap between services and communities.

Leeds neighbourhood networks

The Leeds Neighbourhood Network comprises 37 voluntary organisations across the city working with members and volunteers to improve health and wellbeing. Through a range of activities like advice and information, help around the home, and healthy living activities, the network promotes community participation, social connection and healthy ageing at a local level. In a recent evaluation, the network’s innovative approach was shown to address three stages of healthy ageing:

• Preventing ill health through community-based activities and support, helping people to manage long-term conditions
• Delaying illness severity and maintaining a good quality of life, as well as easing the demand on health and social care services
• Reducing demand pressures on healthcare providers by assisting individuals with significant support needs, including frail older people or those with chronic or multiple conditions such as dementia or cancer

North Central London ICS

In line with the Core20PLUS5 agenda to reduce health inequalities, people in North Central London with influence in their community are helping other residents engage with health services. These ‘Community Connectors’ offer health checks and link local people into self-management support. Offering unique insight into the barriers people living in their communities’ face, connectors enable excluded communities to have a stronger voice and are ideally placed to advise local NHS services on how these can be overcome and what makes a good service. 

Involve Northwest/Wirral Council

In the Wirral, a Community Connector programme draws on asset-based community development (ABCD) principles and behaviour change principles to address health and wellbeing locally. The Community Connectors are commissioned by the Public Health team at Wirral Council and are employed by a third sector partner, Involve Northwest. Connectors serve as the missing link between residents and public services and identify what support is needed for people to move forward and achieve their aspirations. To do this, they visit people at home or in a place of their choosing and offer support around specific challenges, goal setting and signposting to activities and services. More than 5,000 people in the Wirral are taking part in the programme.

As the grid below shows, these approaches benefit people, communities and the health and care system, leading to reduced GP appointments, lower A&E attendance and less demand for a range of other services that are under pressure.

While the beginnings of a new community paradigm are emerging that hold promise for the future of the NHS, the value of working with communities for good health and wellbeing is absent from the workforce plan. Perpetuating a deficit-led approach, the plan presents the system as a vehicle for treating illness rather than preventing it and enabling good health.

In doing so, it misses what many in the NHS have already grasped. From North London to the Wirral, it’s clear that investing in communities can provide solutions to some of our biggest health and care challenges. The training and retention of staff and the reform of how they practice are necessary steps to ensuring the NHS survives to its centenary. But opening its doors to the talents, energies and insights of communities, are what we need for the institution – and its staff – to thrive.

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