News

Gathering together to review our plans for winter, stark reminders are all around of the challenges ahead.  Covid-19 is back with a vengeance, and some key people can only join remotely as they recover.  The rising caseload of routine medications is putting real pressure on community nurses.   And as things always come in threes, the broadband network at one of our sites has just gone down.  

All in a day’s work you might say but looking ahead to winter feels different to me.  After 25 years of winters in the acute sector I’m now experiencing it from the community perspective at CSH Surrey.  It’s different too because of the intense level of change in our system, and the wider social and economic context of that change.  It really feels like the future will be very different from the past, and that brings fear and excitement in equal measure.  Whilst the NHS 10-Year Plan is (to me at least) a welcome, clear, and sufficiently radical and ambitious statement of intent there’s still a lot to be filled in between the broad structure and ambitions. 

I have to admit though - that’s the bit which makes me more excited than fearful.   As a social enterprise we exist to find opportunities to create social value, and I find the 10-Year Plan to be open to that, as an essential component of the health and care landscape and strategy.  Social value is about equal opportunity for people to stay well and active, independent and with potential for fulfilling lives.  It’s not about treatment.  It’s about prevention of illness – so fully aligned to the plan but of course needs the NHS to break away from years of entrenched treatment-oriented processes.  This is not going to be easy.  

The public, though, are genuinely interested in health and wellbeing, making the UK health and wellness market the fifth largest globally, valued at $224bn in 2022 (according to Google).   So, shifting to prevention means fully engaging with the interests and motivations of the public, recognising that there is a huge difference between the haves and the have-nots in this.  A social value approach, focused on equity and the opportunity for all to participate, is essential.   This is why, alongside GPs and hospitals, social enterprises and the voluntary and community sector more widely are critical players if the plan is to be successful.

Voluntary sector

I’m also privileged to be able to view this from the voluntary sector, as a trustee of the incredible Holme Farm charity that supports community wellbeing and biodiversity.  

Everything about Holme Farm is focused on wellbeing and independence, with independent research finding that around three quarters of participants report improved mental and physical health.    Gareth is one of the regular volunteers, working outside and in the workshop.  He first came along after being asked to try it by the local mental health team.  Since then, he’s not missed a day in over a year.  

By talking to others there he gets a kind of support he didn’t find with professional input – others with similar stories who can listen or share experiences.   And he’s generating social value himself – although he wouldn’t describe it like that – by supporting the charity and others who come along, creating a beautiful garden and attracting donations and support.

Charities like Holme Farm exist across the country and represent an incredible resource for sustaining population wellbeing.  Just take a look at Kate Crossan’s report from late 2024. But despite real interest and involvement from our local primary care team it still feels almost impossible to us to be integrated within the wider health and care system. 

Different worlds. 

One is built on systems, assurance, standards and professions.  The other goes straight for practical, needs-based support.  Both are essential but they need to meet and work together.  What they have in common is their remit to meet the needs of the communities and people that they serve, and in the concept of Neighbourhood Health, so central to the 10-year plan, there is a genuinely new opportunity to achieve that coming together.   And it is here that once again a social value approach is essential, recognising the assets available to communities and harnessing those to leverage even greater value.  In the case of Holme Farm this multiplier effect is estimated to be as high as 16-1. 

That’s where opportunity is, and for a social enterprise delivering community services those opportunities feel substantial.   At CSH Surrey we’re already off the mark with AI, now actively deploying digital solutions and with a clinically-driven pipeline of new initiatives.  We’ve been chosen to lead the integration of our community patient record with the NHS App so that people can directly manage their community appointments and access their records and results.  Our nurses and therapists are already delivering highly complex and person-focused care to achieve and maintain independence, keeping people out of hospital.   Our community urgent care services, run in partnership with local GPs, work alongside ambulance services to provide urgent care in the home.  People are remobilised following a fall, have point of care diagnostics in their home, and even access to mobile x-ray to prevent any unnecessary trip to the emergency department – or A&E as it used to be known.  

Mind the gap

This is where we operate, between community and personal health assets, and the statutory health and care services.   We are an essential partner to primary care, adding in nursing, therapy and practical wellbeing expertise.  Social enterprises along with other social value and community focused organisations such as community interest companies (CICs) and charities can do what no other part of the system can do – joining up these different worlds to meet the needs of people and communities.  

Inevitably there is a need to shift some resources upstream but there are innovative approaches to that already taking place, for example in West Herts (First-of-its-Kind Partnership to Revolutionise Community Healthcare in the UK :: West Hertfordshire Teaching Hospitals NHS Trust). Each area will need to define its own approach based on models that emerge, and genuine, open partnership focused on the common goal of improved community wellbeing is essential for success. 

So despite the grey skies and gloomy predictions for winter I still feel there are grounds for hope.  One of these is simply the incredible dedication and skill of the community health teams.  Another is knowing that there are wonderful volunteers working every day to support wellbeing and combat loneliness and other social problems for so many people.  Across these and the statutory services we have much more in common than it often feels and the great opportunity – and the third reason for hope – is of true co-creation and collaboration in Neighbourhood Teams. 

National media interest often draws attention to the very real problems that winter presents but the voices that might be able to make the biggest long-term difference are often not heard.  So – there is a responsibility amongst those of us who work most closely with communities to get those voices heard, making the case for continued support and investment in care that actively keeps people independent and at home, and in the marvellously varied, diverse and tailored community-owned projects and schemes which add so much value and mean so much to people not just in winter but the whole year round.

A lot of this feels quite a long way away from today’s work of signing off the winter plan.  But the next six months are a critical time for us on both fronts, and our teams know that – they’ve come up with brilliant, creative ways to enhance services without impacting on our core capacity. 

Winters are always challenging but we will make sure that keeping people well in their homes, connecting them with support and adding social value, remains our focus.  That’s what we do.

And the broadband network is back up.

Tom Smerdon

Interim CEO.