استعرض مصدر Moving care to the community: an international perspective

==Executive summary==
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.