Efforts to move the care of children and young people from hospital-based settings into community services are facing substantial hurdles, according to a new report by the Nuffield Trust. The independent health think tank has identified a range of systemic issues, including chronic workforce shortages and inconsistent funding, as primary barriers to achieving this strategic goal for the NHS.
The report underscores that while the ambition to provide more care closer to home is widely supported, the practicalities of implementation remain elusive. A significant challenge lies in the availability of a skilled workforce. There is a particular scarcity of specialist community paediatricians, mental health professionals, and allied health professionals suchuding physiotherapists and speech and language therapists, who are essential for delivering comprehensive community care.
Furthermore, the Nuffield Trust highlights concerns over the fragmented nature of funding streams and a lack of a cohesive national strategy to drive this shift. Community services often receive less attention and investment compared to acute hospital services, creating an imbalance that hinders their capacity to expand and innovate. This disparity in resources makes it difficult for community teams to build the infrastructure and capacity needed to take on more complex care formerly delivered in hospitals.
The COVID-19 pandemic has also exacerbated existing pressures on community health services. While hospitals saw a temporary reduction in some elective procedures, community teams were often on the frontline, managing increased demand for mental health support, long COVID care, and routine health checks that had been delayed. This additional strain has further stretched an already under-resourced sector, making the transition to community-based care even more challenging.
Looking ahead, the report suggests that the newly established Integrated Care Systems (ICSs) will play a crucial role in overcoming these obstacles. By fostering greater collaboration between health and social care providers, ICSs have the potential to develop more coordinated and patient-centred pathways for children and young people. However, the success of these systems will depend heavily on sustained investment, strategic planning, and a renewed focus on recruiting and retaining the necessary workforce.
Ultimately, achieving a successful shift towards community-based care for children and young people requires a fundamental re-evaluation of how health services are planned, funded, and delivered. Without addressing the root causes of workforce shortages and inconsistent investment, the aspiration of providing care closer to home may remain just that – an aspiration.
Source: Nuffield Trust