Moving care to the community: an international perspective
2012 Royal College of Nursing
Policy briefing 12/13 March 2013 (updated December 2014) Publication code: 004 450
Moving care to the community: an international perspective
RCN Policy and International Department 020 7647 3723 Email: policycontacts@rcn.org.uk www.rcn.org.uk/policy
Executive summary[عدل]
The Royal College of Nursing (RCN) is the UK‟s largest professional association for nurses, midwives, health visitors and health care assistants with more than 420,000 members. The movement of care from acute hospitals to the community is an international priority. Many countries acknowledge the need to improve productivity whilst reducing or stabilising health care costs. Furthermore, global drivers for change such as rising patient need; an ageing population and workforce; demand for care to be delivered closer to the patient‟s home; and reducing unscheduled health care use, are putting more pressure on health systems to deliver safe, timely and quality care.
The RCN has worked closely with other national nursing associations (NNAs) to understand how similar moves have been implemented in their own countries and identify learning opportunities for the UK. The RCN‟s analysis of the shift has shown that each country is starting out at a different point in the reform process with diverging national priorities, and as such, the success of this shift is difficult to evaluate.
Key messages
To effectively shift care out of hospitals and re-provide these services in the community, a whole-system approach is needed. Hospital restructuring cannot happen in isolation but must go hand-in-hand with reinvestment strategies. Otherwise, there is a possibility of creating a transition gap in service provision.
Internationally, there is much focus on integration and co-ordinated care as a means to improve continuity, reduce fragmentation within the health and social care systems and deliver good patient outcomes. Nurses play a pivotal role in supporting and promoting better coordinated care. Where integrated care models have been successful, there is evidence to show that close collaboration between local authorities, commissioners, service providers and frontline staff have been instrumental in that success.
Investments must be made to strengthen the community nursing workforce if the rising challenges and demands of an ageing population with more complex and multiple health and social care needs are to be met. The community nursing workforce is already under tremendous pressure due to workplace shortages, downbanding of nursing roles and an ageing community nursing workforce set to retire over the next decade. Priority must be placed on enabling and supporting nurses through education, training, and developing leadership skills to ensure the right nurses with the right skills are leading the way.
Forewords[عدل]
Moving patient care out of acute hospitals and into the community has been a UK-wide priority for over a decade; however despite national commitments made to encourage this shift, there is limited evidence to show a tangible investment in the community. Moreover, our Frontline first campaign has highlighted concerning examples of service and staff cuts and the impact of these short-term savings on patient safety and overall quality of care. The RCN is very supportive of moving care closer to patients‟ homes, where it is clinically appropriate to do so; however we believe that more community investment is needed to facilitate this shift.
Advancements in medical and health technology have enabled the population to live longer, however more people are living with co-morbidities and needing complex care interventions. In the UK, there is a push to deliver value for the taxpayers‟ money and build a sustainable health and social care service for future generations. We know that investing in community services and the community workforce will help to deliver positive health outcomes and free hospitals to provide more acute and specialised care. Community and specialist nurses, and advanced nurse practitioners, continue to play a key role in taking this reform forward. These professionals often work at the interface of health and social care and are instrumental in co-ordinating patient care pathways following discharge from hospital.
The UK does not have all the answers when it comes to nursing best practice and policy and there is much we can learn from our international colleagues. Moving care to the community: an international perspective sets out the international thinking behind the acute to community shift, the types of policies and programmes implemented in various countries and offers learning opportunities for the UK. The report also highlights international trends and makes recommendations for commissioners, providers, governments, policy experts and clinicians on a way forward.
Peter Carter Chief Executive & General Secretary
The Queen‟s Nursing Institute (QNI) welcomes this report and believes that there is much to be learned from sharing experiences with our nursing colleagues in other countries. The comparative European data presented shows the UK to have the longest length of hospital stay. This is an unsustainable position economically and we know that patients prefer to be cared for, where appropriate, in their own homes.
This report brings together innovative ways in which the need for more nursing care in the home has been met in other countries. The message is clear: if the UK is to succeed in moving care out of hospitals and into the community we need a whole system and mind set change at the policy, practice and education levels. Integrated working by acute, community, primary care and social care services - and the community nursing workforce - is critical to such a change.
