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'It’s time to stop talking about moving healthcare into the community – just get on and do it'


The need to provide more services in community settings is certainly not a new idea. In fact, it’s probably mentioned in some way or another at almost every healthcare event I attend.

However, it got more than a few mentions at the annual conference of the Queen’s Nursing Institute, held earlier this week in London.

Among those discussing increasing community care was Caroline Dinenage, the care minister for England, who arguably has the power to effect such a change.

“Out-of-hospital care should become a bigger part of what the NHS does,” she told delegates at the event for district and community nurses.

She added: “It’s what people who use services want – who doesn’t want to recover in their own home, surrounded by family, friends and familiar things?”

Of course, Ms Dinenage is by no means the first person in government to chance upon this idea. Over a decade ago, the government launched its Transforming Community Services programme.

“The fact that we are still talking about the need for this to happen raises a few significant questions about the impact of the programme”

Launched in February 2008, the three-year programme – as its title suggests – was supposed to be the policy vehicle that would lead to lots of services swapping from acute to community settings.

The fact that we are still talking about the need for this to happen raises a few significant questions about the impact of the programme – but this is all history now.

As we are always hearing, particularly as we approach winter, our hospitals are nearly always jammed full of patients, with every bed and bay in virtually constant use.

What the public hears less about is the pressure faced by community and district nursing staff as they try to provide the preventative or follow-up care that either keeps or gets patients out of hospital.

“Much of what you do goes unnoticed and that simply must change,” noted Ms Dinenage in relation to the profile of community staff during her speech. I agree completely.

“I think everyone is also pretty much agreed that we do need to provide more services in the community rather than in hospitals”

I think everyone is also pretty much agreed that we do need to provide more services in the community rather than in hospitals.

But there are two parts to this process, because it is about transferring services rather than simply shutting them down. In my book, this is where the whole idea keeps breaking down.

It’s all well and good closing hospital services – even if it does make the public nervous – but you have to then ensure that the same service has been adequately set up and provided in the community before the hospital service is closed.

If I’m honest, I get tired of hearing about the need to shift services into the community. I just wish someone would actually get on and do it – and actually invest in the necessary staff and resources.


Readers' comments (3)

  • Well said - there really is a glaring gap between the rhetoric and the reality about investing in community services. The NHS seems to be getting more reactive and less proactive. Do politicians really believe in investing in prevention rather than cure? Yes, self-care has a big role to play, but many people need community nursing support to achieve this.

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  • It would also help if family members didn't use a variety of excuses to refuse to help or provide support their relative. It's always someone else's responsibility

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  • Tats so true, there aren’t enough resources and our existing community services are stretched to limit. Bed blocking is a symptom of the same underfunding

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