Key Insights from the panellists 

Siobhan Melia: community services are essential but under-recognised 

Chief executive, Sussex Community NHS Foundation Trust; National Advisor for Community Health Services 

Siobhan stressed that community services are already a major part of the NHS, with around 200,000 contacts taking place every day. Despite this scale, national focus and investment still lean toward acute activity. She argued that community teams are the true foundation of neighbourhood health and should be recognised and planned for accordingly. 

Her key points included: 

• The community workforce has a distinct professional experience and requires tailored investment and development 
• Data foundations need strengthening before digital innovation can scale 
• Current financial flows make left shift difficult because incentives are still largely tied to acute performance 
• Proven models such as urgent community response, frailty pathways and virtual care are ready for wider adoption if commissioning structures support them 

Lisa Hollins: voluntary sector models deliver measurable prevention and system impact 

Executive director (UK), British Red Cross 

Lisa outlined how the British Red Cross has developed an outcomes framework shaped by communities and major charities. It focuses on improvements in wellbeing, reductions in system use and measurable social value. The approach provides a clear and comparable evidence base for commissioners. 

She highlighted that: 

• High intensity user services have delivered notable reductions in Emergency Department attendances, bedded admissions, ambulance use and mental health liaison referrals 
• Prevention models must actively target inequality since social determinants drive repeat crises 
• Many smaller community groups need support to participate in commissioned models 
• Commissioners should feel confident investing in community prevention because strong evidence now exists 

Christy Francis: CICs demonstrate the left shift in practice through scalable models 

Chief operating officer, City Health Care Partnership CIC 

Christy presented three examples where his organisation has delivered tangible left shift at scale. The community frailty model at the Jean Bishop Centre provides proactive multidisciplinary care that has significantly reduced emergency admissions, GP contacts and care home conveyances. Strong partnership working underpins the approach. 

He also described: 

• A co-located urgent treatment centre that now diverts around 100 patients per day from ED 
• Careful cultural and workforce engagement that supported staff transitioning from acute to community settings 
• Intermediate care transformation that shifted capacity toward home-based pathways 
• In-house domiciliary care that enabled faster discharge and a 60%+ reduction in numbers of patients with no criteria to reside in acute beds 
• Christy noted that CIC flexibility, the ability to reinvest surpluses and a culture of innovation help accelerate change. 

System-wide themes 

Across the contributions several consistent themes emerged: 

• Financial structures remain a core barrier, with funding still flowing more easily to hospitals than to community services 
• Inconsistent data definitions limit the visibility and credibility of community activity and hinder scaling  
• Community workforce models need strengthening, along with closer collaboration with primary care and voluntary partners 
• Strong evidence already exists for what works, yet adoption is uneven and often dependent on local leadership 
• National metrics still focus on acute performance, which limits incentives to invest in models that keep people well at home 

Conclusion 

The roundtable demonstrated that the left shift is both possible and already underway in many areas. Community providers, CICs and voluntary organisations are delivering models that keep people well in their homes, reduce avoidable hospital activity and improve quality of life. Their challenge is less about proving impact and more about overcoming structural barriers to scale. Progress will depend on commissioning that reflects population need, financial flows that support prevention and metrics that value community outcomes alongside acute performance. 

We would like to express our gratitude to Lord Victor Adebowale for chairing the roundtable and to our panellists Siobhan Melia, Lisa Hollins, and Christy Francis for their hugely insightful presentations and contributions. We would also like to thank those who attended for their engagement and perspectives.  

The PSC exists to make public services brilliant. If you would like to talk about any of the topics raised in this roundtable further, or how we can support your organisation to deliver the left shift, please get in touch with Chris Bradley at chris.bradley@thepsc.co.uk.