Complex picture of NHS community care revealed by new analysis

New analysis by the Health Foundation has revealed that the while the biggest contracts for community care are held by NHS providers, the health service is also reliant on services offered by charities, local authorities and private sector companies. Most contracts are short-term and the majority of non-NHS contracts are for relatively small sums.

Around £10bn was spent on NHS community care in 2016/17, for services such as community nursing, health visiting and occupational therapy.

Following a freedom of information (FOI) request in August 2016 for contracts covering 2016/17, the Health Foundation received details of 7,494 contracts awarded by the NHS for the provision of NHS funded community care from 161 (78%) clinical commissioning groups (CCGs).

Key findings based on these data show that:

• NHS providers hold over half (53%) of the annual financial value of the contracts for community care awarded by the health service. Private providers were awarded 5% of the total value of the contracts, the third sector (charities) were awarded 2% and GPs were awarded 1% of the value. The remainder went to ‘other’ providers (36%) – a diverse group made up of community interest companies, social enterprises, local authorities and others reported as non-NHS.
• Looking at the number of contract shows a different picture, with private providers holding more contracts (39%) than NHS providers (21%). GPs held 12% of contracts, the third sector 11%, and other providers 13%.
• This shows that contracts awarded to NHS providers tend to be of higher value then those for non-NHS providers. The average annual contract value for the NHS was over £3.5million. For the private sector it was £200,000, for the third sector it was £250,000.
• Three-fifths (58%) of contracts were reported to last just two years, with nearly half (45%) for 12 months or less.

Involvement of non-NHS providers in community care has grown rapidly in recent years. In 2010/11, data from primary care trust accounts showed that non-NHS providers accounted for 20% of all community care spending. In 2012/13 the figure was 31%.  This latest research – which is based on a large sample but is not comprehensive – shows 47% was provided by non-NHS providers.

Adam Roberts, Head of Economics at the Health Foundation, said:

'The vast majority of people believe in a national health system that is tax funded, free at the point of use and which provides comprehensive care for all citizens*. But there is less consensus when it comes to who provides the care, with two fifths (39%) of people saying they prefer their care delivered by the NHS, and a slightly higher proportion (43%) who do not have a preference.

'Regardless of who is providing NHS community care, contracts for these services – which include community nursing, health visiting and occupational health - need to ensure care is delivered efficiently and to a high quality, while encouraging long-term planning.'

Media contact

Creina Lilburne
Creina.lilburne@health.org.uk
020 7257 8027

Notes to editors

* In February 2015, the Health Foundation published Public Attitudes to the NHS, which analysed questions from the 2014 British Social Attitudes Survey. Nearly 3,000 (2,878) adults from across Great Britain were surveyed. Of those surveyed, 89% agree that the government should support a national health system that is tax funded, free at the point of use and provides comprehensive care for all citizens. While people support the funding principles of the NHS, they are much less attached to the idea of the NHS as their preferred provider of care, according to the research. Thirty-nine per cent (39%) of respondents prefer their care to be delivered by an NHS organisation, but even more people (43%) do not have a preference between receiving NHS-funded care from an NHS organisation, a private company, or a non-profit body such as a charity or social enterprise. However, responses vary markedly between generations, with younger generations less committed to the idea of the NHS as a provider of care than the older ones.