Promises to bring more patient care closer to home by prioritising NHS community services have fallen flat, a report has claimed.
National strategies under successive governments have concluded that the NHS must do more to help people stay well in their own homes - avoiding the need for hospital treatment - if the health service is going to be financially sustainable.
But NHS Providers, which represents NHS trusts in England, said this expansion of community services has failed to materialise, with those that do exist being overstretched, underfunded and understaffed.
NHS England's Five Year Forward View envisaged a significantly expanded role for community services, such as district nursing, physiotherapy and health and wellbeing services such as sexual health.
But NHS Providers said its report found more than half of community trusts (52%) said funding in their area had fallen in this financial year.
The report highlights findings from a survey of NHS trust leaders - including more than half of those providing community services - which show nearly half (44%) said they were cutting costs while just under a third (30%) had cut staff.
More than four out of five of all provider trusts (82%) were worried or very worried that community health services would not receive the investment they need to deliver the ambitions of the Five Year Forward View.
Meanwhile, the majority (91%) said that based on current trends, the gap between funding and demand for community services will grow over the next year.
The report, NHS Community Services: Taking Centre Stage, concludes that these services are not sufficiently understood or prioritised at national or local level, and are held back by burdensome competition and procurement rules.
It said the lack of national-level data, quality measures and targets has also hindered progress.
The report also presents many examples of good practice where community service providers have successfully developed new ways of working and collaborating with other services to improve care for patients.
It describes the galvanising potential of community services to help people stay well, and highlights examples of innovation and good practice which demonstrate the enormous value of NHS community services in keeping people well and able to live independently even with serious complex conditions.
NHS Providers chief executive, Chris Hopson (pictured), said it is patients who are paying the price as the rest of the health and care system struggles to keep up with rising demand for treatment.
He added: "There is a real opportunity for NHS community services to take a leading role in the transformation of health and care services.
"They are in a unique position to act as integrators, working across boundaries and collaborating with other parts of the public sector to tackle health inequalities.
"They have played a central role in delivering new models of care, working with GPs, nurses, hospital specialists, mental health and social care services to deliver integrated care in the community.
"And yet - as our survey makes clear - all too often NHS community services are marginalised, underfunded and short staffed."
Matthew Winn, chief executive of Cambridgeshire Community Services NHS Trust, said: "The pressures facing hospitals are tangible and widely reported, but the steep rise in demand, coupled with the complex needs of people living at home are largely ignored and hidden.
"This report shines a clear light on a sector that needs greater support and national leadership to help realise the ambitions of supporting more people to be cared for safely at home."
BMA council chairman Dr Chaand Nagpaul said: "This report is further evidence of the damaging impact of underfunding in community services by successive governments, exacerbated by financially driven competitive tendering and procurement of services that has eclipsed the quality and stability of patient care.
"At a time when ministers have voiced their support for patients being cared for in their own homes, the reality is instead an impoverished infrastructure of community services, robbing patients of their independence with the added distress of unnecessary hospital stays and discharge delays.
"Given the current crisis within the NHS, with increased waiting times, rising bed occupancy levels and extreme pressure in hospitals and GP surgeries, adequate care in the community is vital to relieve the strain on services.
"The government must come up with a realistic solution to solve the current crisis in community care - one that delivers the investment necessary to ensure a health service that is collaborative, supportive and delivers the best possible care for patients."
An NHS spokeswoman said: "This report highlights the inescapable pressure on GPs, hospitals and community services from a growing, ageing and sicker population, which will have to be properly factored in to NHS funding decisions for the decade ahead."
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