If it feels like governments have been discussing the shift towards providing a greater proportion of healthcare outside of hospitals for years, that’s because they have.
When Labour came into power in 1997 it set out to give primary care a lead role in commissioning and providing services with Our Health, Our Care, Our Say. Nine years later it tried again with Transforming Community Services; like its predecessor, this initiative failed to achieve the government’s aims.
Fast forward to today and the latest government initiative, the Better Care Fund, is in trouble before it has even launched. The Cabinet Office has demanded more robust evidence on how the promised cost savings will be achieved.
I don’t underestimate the enormity of the task of shifting services out of hospitals – particularly if social care is also to be integrated, but it mustn’t be dropped because it’s too difficult.
We know hospital care is expensive, we know patients prefer to receive care at home where possible, and we know that the lines between health care and social care are often blurred. Properly integrated care provided wherever is most appropriate would be cost-effective and popular with patients and their families.
However, “cost-effective” doesn’t necessarily mean cheaper, particularly in the short term when new services need to be up and running before the old ones can be remodelled or dispensed with. And it’s not just about where you put the money – expanded community services need more staff to run them. So why did the district nursing workforce shrink by 40% in a decade while successive governments talked about expanding community services? Surely these nurses will be crucial, however new services might be configured?
The revision process for the Better Care Fund should include an investigation into how to rebuild community nursing services. If care really does transfer into the community, unless they have the support of these highly skilled practitioners patients with long-term conditions will simply end up needing hospital care that no longer exists.