Innovative community care can be marvellous – but instead we’re going backwards

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January 6, 2011 by sharonbrennan

I’m rather appalled that it’s been a month since I last posted. I guess having Cystic Fibrosis, planning for Christmas, New Year, my Mum’s birthday and my 30th birthday have all taken their toll. Truth be told I’m shattered and writing this while wrapped in a duvet eating the remains of a Christmas cake.

As interesting as my tiredness is, it does have a point to this blog. I have a small device under my skin through which I can administer intravenous antibiotics when I need them. The device needs flushing every six weeks and I’ve just got off the phone from the outreach team at Brompton hospital to book in a nurse to come to my home next week to flush it. This means I don’t have to trek to hospital and expose myself to bugs on the ward. Instead I can rest, stay in the warmth and try to get myself stronger while still getting the treatment I need.

Outreach nurses are fantastically important to the way ill and disabled people can maintain their independence and cope with their illness without filling up hospital beds unnecessarily.

During research for a Guardian article, I recently spoke to a patient in Cumbria who was over the moon about the treatment he’d received from a team of outreach nurses. 78-year-old Mr Clancy needed a lengthy treatment of intravenous antibiotics that he could not administer himself, to cure a severe, but one-off, infection. The infection was so advanced that he was very weak and felt unable to commute to hospital every day. His local GP arranged for him to have a nurse visit him every morning in his own home for three months. He firmly believes that if it wasn’t for this service he would have spent 90 days in hospital. In 2002, the cost of a hospital bed was estimated to be €228 per day. Clearly this figure is out of date and would no doubt be higher almost a decade on, but even using this figure Mr Clancy’s three month stay would have cost €20,520, or £17,444. And that figure excludes his actual treatment.

It makes economic sense to improve care in the community as hospital admission is one of the most expensive aspects of the NHS. Local care reduces the risk to patients from costly hospital-based infections, it improves their spirits by ensuring they can get better in their environment surrounded by loved ones and it means that hospitals can focus on treating acutely ill patients.

It is therefore really disappointing to me, as someone who has really benefited from community nurse care, that community care, far from being used to help innovate and improve services, appears to be going backward.

Yesterday’s Guardian headline story revealed that, in a survey of over 500 doctors, 50% now feel ‘bed-blocking’ is worse than this time last year, while 40% feel it hasn’t improved. Bed-blocking is a term used for patients who are well enough to leave hospital but can’t be discharged as there is not sufficient community support to continue their care at home. Often this isn’t even innovative support, such as having traditionally hospital-based treatment administered at home, but is basic adult social services support, such as help with personal hygiene and cooking. Just two stories around this week show that Hull council is looking to scrap its adult residential care entirely and Kingston in Surrey is planning to put up the cost to recipients of its adult social care.

The Government has given the NHS a budget rise of 0.1% a year in order to honour its commitment to the electorate of protecting the NHS budget. But simultaneously local councils are facing cuts of up to 8.9% to their budgets. Consequently many, as the examples above show, are looking to their care bill to see where savings can be made. Cutting local social care will directly impact how much the NHS has to spend on each hospital patient. On top of this the NHS is being forced to find £20 billion of efficiency savings by 2014. I can’t see how it can even begin to achieve this if hospitals find it increasingly difficult to discharge patients into local care because of cuts to council budgets.

I’ve first hand experience of the great things that can be achieved if there is greater care in the community, so it’s such a disappointment to see that even the basics of community care are now under threat. The Government will not make any NHS efficiency savings whatsoever if it doesn’t start to hear the alarm bells ringing up and down the country around the issue of local social services.

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