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EDITOR’S COMMENT

'Recognise the value of community nursing'

The need to provide high-quality community care has been a mantra of successive governments, but we don’t seem to have got beyond just talking about it. But now HEE may be planning to have the nursing resource to actually do it.

Many patients want - and need - to receive high-quality care at home. Increasingly, we have seen schemes to speed up discharge and provide more care at home, as well as more nurse-led outpatient clinics that give access to care while keeping patients out of hospital.

Caring for patients in their homes is the future of nursing. It is often better for patients’ psychological wellbeing to be looked after in their own environment. It can offer them a “normal” routine, increased independence and ready access to the people they love in a familiar setting - the power of that should not be underestimated.

The potential to offer high-quality community-based care is in no doubt, and it can also save money to care for people without paying for a hospital bed. But providing truly integrated services means the profession needs to swell its numbers in the community.

Caring for patients in their homes is the future of nursing. It is often better for patients’ psychological wellbeing to be looked after in their own environment

Despite that, our news analysis piece on page 8 reveals providers predicted an overall reduction in the community workforce of 1.5% in 2013-14 and 2.1% in 2014-15, with no growth up to 2018 (pages 8-9). Health Education England, tasked with devising a workforce plan to ensure the NHS has the right skills and numbers to deliver care, has rejected those figures. It believes far more community nurses are needed to deliver care closer to home, and, of course, it is right.

As Steve Field, chief inspector of general practice, said at the chief nursing officer for England’s summit at the end of last year, not enough nurses are being trained in a way that equips them to work in the community. We need to address this.

But it’s not the only thing that needs to be addressed. For too long, community nurses have been considered the poor relations of hospital nurses, working in a professional backwater offering a limited range of care. This is simply not true. Community nurses have the expertise to carry out an expanding range of procedures and manage caseloads of patients with some of the most complex needs. These nurses need to shout about the great work being achieved to continue to attract our best nurses into the setting.

As a profession, nursing must respect and recognise the importance of nursing both in and out of hospitals. Only then will the health service be capable of delivering truly patient-centred care, because it will be less about where care is delivered, and more about who is receiving it and what they want and need.

Jenni Middleton, editor

jenni.middleton@emap.com. Follow me on Twitter @nursingtimesed

Readers' comments (4)

  • It would be nice to see NT articles looking at the situation in Scotland and Wales too or is the Nursing Times just for England?

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  • For too long, community nurses have been considered the poor relations of hospital nurses, working in a professional backwater offering a limited range of care. This is simply not true. Community nurses have the expertise to carry out an expanding range of procedures and manage caseloads of patients with some of the most complex needs.

    Further to these comments in the article it is all a matter of perspective. We who work in the community consider 'hospital nurses' to be ill equipped and lacking in knowledge when they start work in the community. In fact there is a little heartsink moment when you realise that your new staff nurse has no previous community experience, due to the vast amount of training and input that is needed to get them up to speed. Please don't misunderstand me we welcome new staff with open arms. I am just saying we do not consider ourselves to be working in a 'professional backwater' rather we work in a very dynamic, challenging and at times very stressful environment that calls for an extremely wide skill set.

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  • Good heavens have they in the positions of power had a lightbulb moment?How many years has this taken? I adore community work and would hate to work in a hospital again-roll on the community nurses-we are great!!

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  • Community nurses are the best thing about the NHS.

    WE keep vulnerable people out of hospital, not GPs. There isn't enough money in the GNP to pay a GP to change a wet bed or a soiled inco pad, let alone do it out of office hours.

    Palliative care absolutely relies on highly skilled community nursing teams 24/7, but there are weak links in the chain where there isn't a nearby specialist hospice or easy 24 hour access to pharmacy or community equipment stores.

    I left hospital nursing in 1981 and never wanted to return. Hospital nursing teams are less well organised than community teams and individual nurses don't seem to feel that care is their individual responsibility to arrange and deliver.

    It makes a world of difference to work in a good community nursing team. We can give better quality of care, provided we have enough proper community qualified staff. Our job satisfaction is build directly on patient satisfaction and supporting carers.

    Working without the big organisation around you may be scary at first because you're more aware of your individual responsibility, but this is the best job in nursing!

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