Community healthcare entered the spotlight last week when the new chief executive of NHS England Simon Stevens signalled his intention to concentrate on smaller community hospitals offering care closer to people’s homes, particularly for older patients.
Speaking to Nursing Times’ sister title Health Service Journal and The Telegraph, his comments have been taken by the national media to signal a shift away from centralised hospitals offering large centres of specialised care. They have been on tenterhooks to see how this new broom would challenge and change the NHS he has inherited.
It’s often been stated a shift into the community would make better sense economically and provide a better experience, but is it really equipped to deliver the vision of the new man at the top?
Well, while Mr Stevens was espousing the beauty of care being offered in local communities, the community was calling out for help. In a survey of over 1,000 community nurses, the Queen’s Nursing Institute has discovered the sector can barely cope with its workload now, let alone any increase (see news, page 2).
Mr Stevens’ intentions are all very well, but while the Francis, Keogh and Berwick reports have been focusing everyone’s minds on the quality of the hospitals, no one has really thought that we have just as many problems stored up in the community workforce.
The survey found that only just over a quarter of respondents thought their teams were adequate to manage their caseloads, but worryingly many felt that a large number of patients were not receiving the right care.
The report, 2020 Vision - Five Years On: Reassessing the Future of District Nursing, updates a landmark QNI study published in 2009. It paints a picture similar to the findings of reports Nursing Times has published on the hospital workforce - low morale and overstretched staff working extra hours to ensure patients receive adequate care.
Of course, the government’s response is likely to be to highlight the holy grail of the Nurse Technology Fund. Deployed in the community effectively, this money will provide some much-need IT to support nurses out in the field, but it is not the panacea. Just as in hospitals, resources are stretched to breaking point.
If you want better care, you need more nurses - train more and keep the ones you have. The entire NHS is stretched so you can’t just move the problem - you have to fix it. Let’s hope Mr Stevens does that.
Jenni Middleton, editor
firstname.lastname@example.org. Follow me on Twitter @nursingtimesed