Adrian Hayter – who joined NHS England in 2019 – is now stepping down

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Community services need new national funding bid, says outgoing NHS England director

By Dave West 18 December 2023​

• Adrian Hayter – who joined NHS England in 2019 – is now stepping down
• NHSE community programmes have expanded, with virtual wards, enhanced health in care homes, urgent community responses, and proactive care
• But a major government funding settlement, and workforce development, will be needed for community services

The national clinical director for older people has announced he is leaving NHS England and said a major government funding settlement will be needed to maintain progress and take community services to the ‘next stage’.

Adrian Hayter joined NHSE in 2019 as NCD for older people and integrated person centred care and will leave in the new year to join the Royal College of GPs as medical director for clinical policy.

He has been clinical lead for several major community services which have launched and been rapidly expanded since then, including urgent community response; enhanced health in care homes; and virtual wards. A national “proactive care” service for people with frailty, a development of previously delayed proposals for “anticipatory care”, is expected to roll out shortly.

Dr Hayter, who is also a longstanding GP partner in Berkshire, said community services were now much more prominent at NHSE — and in its asks of the service – than they were four years ago. 

He said: “When I first came in, there wasn’t very much in planning guidance about what was happening in the community at all. Now that is different and we are expecting a range of initiatives in 2024.

“But the future is that all of these things are not individual programmes - they’re all part of a particular approach to how we manage and support people for as long as possible in their own homes.

“Urgent community response [where services are required to respond within two-hours to urgent needs, referred from a range of services] and virtual wards are a continuum of care.

“And the growth of virtual wards have helped extend what happens in the community all the way through to the acute level care.”

National long-term funding for several of the new services – badged in the 2019 long-term plan as “Aging Well” – is also now due to end, with integrated care boards instead asked to commission them locally.

Dr Hayter warned that, as well as moving those services closer together, there needed to be a future government spending review settlement aimed at growing community services, to meet the needs of the rapidly ageing population.

This would mean directing greater funding to employ more staff in the community, he said, and ensuring implementation of this year’s long-term NHS workforce plan developed community roles and generalist skills.

Adrian Hayter

Progress could be undermined

Dr Hayter said: “All of this could be undermined by not investing in the [community, older people’s and generalist] workforce. That’s the work for future spending reviews. We are pushing for the older person’s agenda in terms of a medium-term strategy for older people. 

“We’ve got a demographic shift where nearly a quarter of people in the next 10 years are going to be over 65, a doubling of the numbers over 85… Lots of people who are going to be in a category with real complexity and multimorbidity, and another group with some long-term conditions… 

“We’ve got to try to shift to keep resources in the community. I would be pushing to include community services within future spending reviews, and one of the major pushes is on the workforce plan – making sure there is funding around that which goes into the community, not let us be forgotten again. 

“That’s where the opportunity is to take us to the next level. We’ve got to put something in from a spending review perspective. If we don’t, nothing will be achieved,” Dr Hayter added. He indicated that early work was under way on this, but a full spending review is unlikely to take place for some time. 

The 2019 NHS long-term plan, whose five-year funding plan ends in April, said NHSE would ensure the share of spending going to community health and GP services would increase, meaning growth of at least £4.5bn by 2023-24. However, NHSE has not reported on progress, and funding plans were heavily skewed by covid from 2020. Planned national investment in “anticipatory care” was cut last year, and is not expected to be replaced.

NHSE community services director James Sanderson said in a note to colleagues that Dr Hayter’s “contribution was significant in helping to steer the organisation through the challenges of covid and in championing a new approach to supporting older people as part of the long-term plan”.

NHSE has not yet named a new national clinical director for older people and integrated personal care.