The government has conducted a wholesale audit of healthcare across England and is now suggesting sweeping changes to how people access care, including a greater focus on community-based care.
Attempts to shift some elements of care into the community have been tried before. The most well-known recent example is the community diagnostic centre (CDC) programme that launched in 2021.
Earlier this year, Healthwatch England invited local Healthwatch teams to visit CDCs to collect insight into people’s experiences of using these services. Overall, 18 Healthwatch teams visited 22 sites and spoke to 282 people. This research, A Local diagnosis: Learning the lessons of Community Diagnostic Centres, published in August, reveals that patients have an overwhelmingly positive experience of CDCs and that people value the timely and convenient care they offer.
However, the CDC rollout shows there are still opportunities to improve how community-based care is delivered. Non-medical aspects of care greatly impact people’s healthcare experience. And issues like accessibility, signposting and information-sharing still leave room for improvement.
When looking at what a community-based care model might look like, politicians and healthcare leaders should ask, ‘What lessons can we learn from the CDC rollout?’.
Don’t forget to ask
Meeting people’s communication needs is crucial to ensuring that your service is accessible. However, 75% of the people we spoke to said no one had asked if they had any communication needs. Only two sites we visited routinely asked this question, even though it significantly impacts people’s experiences.
Take the Taunton CDC, for example. 78% of the Taunton site users said they were asked about their communication needs, and this was reinforced by the prevalence of posters advising visitors about their rights under the Accessible Information Standard.
The value of this service clearly stood out to the Healthwatch visitors, with one saying, ‘When we visited our local CDC, we heard about great experiences. Almost everyone we spoke to had been asked about their communication preferences.’ Likewise, a patient from Taunton said: ‘I’m used to explaining about my wife’s communication needs. I do everything for her, sort out appointments, etc. Staff were lovely, the way they treated her and spoke to her’.
While addressing communication needs is not a challenge unique to CDCs, when it’s considered part of the wider user journey, we can understand how much of a positive impact it can have on people’s experience when it’s done well.
Waiting is part of the care journey too
Waiting for care and tests can be an anxious experience. This includes the physical waiting environment, to say nothing of the long waiting times thousands of people are facing, and people we spoke to said the welcoming nature of the venue and facilities had a big influence on their CDC experience.
One visitor to the Taunton CDC told us, ‘It’s lovely. It is light, clean and quiet.’ Another mentioned how much they preferred the CDC environment to other settings; ‘So different from a busy acute hospital with all the hustle and bustle and noise’.
People also told us about the benefits of services feeling local. We heard how care in CDCs ‘feels more personal’, with one person saying, ‘So now I see friendly faces, it’s local, I’ve gotten to know the people who work here… This helps to destress me when people know you’.
In one of the more unique examples of localisation, after visiting Bexhill CDC, a Healthwatch representative explained how the site used to be a well-known car showroom, and they have incorporated elements of this history into the décor, helping to make it feel like part of the community;
‘The site was previously used as a car showroom and repair garage. It is still known locally for this history, and there is artwork on the walls drawing on the themes of car diagnostics and X-rays.’
Getting where you need to go
Finally, and it might seem obvious, but providing good care starts with being able to get to an appointment. Good wayfinding design is essential when creating new services on either new or existing sites.
We visited sites with excellent signage, where patients were given maps and detailed instructions with their appointment letters. The CDC at James Paget University Hospital stood out as a great example – people told us how easy it was to find their way; ‘It was easy to find, signposted, and a map was provided’.
When visiting CDCs elsewhere, people expressed frustration at poor signage and the lack of directions. At one site we visited, every single person we spoke to told us about how hard it had been to find their way around.
What can we conclude?
Shifting to a community-based care model will inevitably bring many challenges. However, policymakers and service designers can get ahead of the game by listening to people’s priorities to better understand the issues that are most important to them.
At Healthwatch, our network of local teams stands ready to help promote community-based care by collecting people’s experiences and highlighting what good service delivery involves.
