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'Is the community able to deliver Stevens’ vision?'


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 Follow me on Twitter @nursingtimesed


Readers' comments (7)

  • Does that mean he will force trusts to restore the cuts already made to community teams (certainly true in MH)?

    Restore the posts removed (sorry, "re-structured", must remember to use the approved language) such as my old Band 7 post? Which forced me into early retirement...And I am by no means alone in this.

    As with much of this sort of pronouncement, not holding my breath.

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  • Hah. I suspect this is mere exhortation to please the political bosses and that in practice, nothing much will happen.

    The damage to community health services through neglect and withdrawal of funding means that even seriously ill or disabled people at home have to rely on a combination of family carers (mostly exhausted and depressed, if not ill themselves), charities (Hospice at Home, Marie Curie) and that new Poor Law provision they call 'social care'.

    If family carers cannot cope, the only option is a care home, since the acute care sector is so keen to prevent anyone blocking a hospital bed.

    The NHS seems to have opted out of any comprehensive longer term provision for older and disabled people and I am saddened to witness the effects on families every day. Even hospices only get a minority of their funding from the NHS commissioning. It's shameful.

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  • Most community Hospitals have been closed and sold off, is Mr. Stevens proposing to buy them back again???

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  • Isn't this all a ploy to force privatisation,

    "what they want is professionally competent and knowledgeable nurses , and lots and lots of them at labourers salaries, or maybe even volunteers "!!!!!!!!!!!!!!!!!!

    I was always proud of my nursing skills and of my nursing knowledge and improving and being up to date, what for?. the way band/ grades/ points keep changing, salaries lowered, hospitals made into Trusts , then centralised more , then de centralised, A&E s shut, now Govt can shut them when they want to, now hospitals needed again, We will be back to Sarah Gamp

    It is all too depressing, We had so much, our skills were advancing , BUT, Because most nurses are compassionate we may have given too much and are not respected for it, also for good care more people are needed to deliver the care and that is costly ,.................. people want to make money

    I can't go on with this litany .............until people are important every ploy will be tried with the underlying motive of greed

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  • why doesn't anybody question the government about their privatisation programme and what their future plans are to put an end to all of this speculation and doubt? It is now time they put all their cards on the table and sought advice and approval from frontline workers, the patients and the public.

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  • Care effective care that is, whether in the community or hospital has to be delivered by willing/ dedicated, valued and skilled persons be they registered or not.

    And what is at the heart of this is money or funding as it is preferred to be called these days, so the cuts being made in all the areas of the NHS no doubt affect the quality of care and does not matter if this is hospital or community based care, there is no quick fix in the business of healthcare!

    How do you or even measure the impact of a community nurse or health worker checking on a house bound elderly person who lives alone periodically as opposed none all? Or which is better, banging them in a care home against their will.....

    It is no wonder that nurse numbers are dwindling because the powers that be see the nursing workforce as easy pickings when it comes to cuts, where they increase nurses workloads whilst cutting pay and reducing their status by way of downgrading in the name of "restructuring" which we all know costs more money.

    After all these you expect the poor nurse to keep giving their best???? There is a threshold for all things more so human beings which nurses are!!!!

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  • 'After all these you expect the poor nurse to keep giving their best???? There is a threshold for all things more so human beings which nurses are!!!!'

    most nurses strive to give their very best whatever the circumstances and the expectations of others. the problem is things go wrong when people, including themselves, perceive or actually find that it is not good enough.

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