Community at the heart of the NHS

In the NHS’ 75th year, James Sanderson, Director of Community Health Services and Personalised Care, reflects on the significant contribution of community health services throughout its history.

With roots dating back to the 19th century, community health services have played a pivotal role in improving the health of the population. These services account for one fifth of the workforce, and deliver over 100 million patient contacts a year. They cover a wide range of services and provide care for people from birth to the end of their life. They support people living with major conditions and complex needs to live independently in their own home for as long as possible. Many services involve partnership working across health and social care teams, along with voluntary sector partners, and include a wide variety of professionals including community nurses, allied health professions (AHPs) such as physiotherapists, dietitians and speech and language therapists, district nurses, mental health nurses and social care workers.

When the NHS was founded in 1948, there were just 7,439 community nurses. Seventy-five years later, 86,000 nurses now support people in the community. The way this model of care has grown and evolved over the years reflects the importance of being able to provide personalised health services to people at home, or closer to their home, where most people want to be.

AHPs are a fundamental part of today’s community health services, performing a wide range of duties and delivering comprehensive healthcare to patients. The term ‘allied health’ was coined during World War II to describe the small number of professions that supported medical care for soldiers, including physiotherapy, radiography and art therapy. During the 1960s and 1970s, there was a move towards preventative medicine and health promotion which led to the establishment of various initiatives, including school health services, health visitor services, and community midwifery. Community psychiatric nurses, dietetics, podiatry, speech and language therapy and other specialisms were added to the increasing range services, and so came the introduction of the first degree-level courses for AHPs, recognising the specialist knowledge required. Today, AHPs make up the third largest workforce in the NHS, with around 200,000 working across health and social care.

Over the years, older people’s health came to be recognised as a more distinct area of care; the 1980s saw the introduction of community care policies which meant geriatric care moved away from institutional settings and towards the community with the opening of day centres, home care services and respite care.

More recently, community health teams have been working more closely with primary care, hospital teams and social care; initiatives like urgent community response (UCR) and enhanced health in care homes (EHCH) are having a marked difference on patient care and keeping people out of hospital who don’t need to be there. The introduction of virtual wards is providing hospital-level care to people at home, helping them avoid having to go into hospital.

Community teams also play a huge role in the delivery of personalised care for patients, enhancing choice and control and supporting people to build the skills, knowledge and confidence they need to achieve their health outcomes.

As the NHS turns 75, I want to thank all the fantastic community health services teams who contribute so much, day in day out. As we look forward to the future, building even stronger services for people in the community, developing greater integrated working, and shifting focus to proactive personalised care will be key to the further success of the NHS.

Our national community health services Twitter feed has been sharing highlights of the evolution of community health services. Please do take a look, share with colleagues and share your own memories and experiences using #CommunityHealthServices.

James Sanderson

James Sanderson is the Director of Personalised Care at NHS England where he leads on a range of programmes that are supporting people to have greater choice and control over their health and wellbeing. James also became the CEO to the National Academy for Social Prescribing (NASP) in 2019 where James leads on creating partnerships, across the arts, health, sports, leisure, and the natural environment, alongside other aspects of our lives, to promote health and wellbeing at a national and local level. View the NASP strategy.

James joined NHS England in November 2015 and was formerly the Chief Executive and Accounting Officer for the Independent Living Fund (ILF). The ILF was an arm’s length body of the DWP and supported disabled people across the whole of the UK to live independent lives through the provision of direct payments enabling the purchase of personal assistance support.

Prior to joining the ILF in 2002, James had a career in the motor industry within a number of sales and marketing roles, in both corporate and retail environments. James is a performing arts graduate with a background in community theatre.