20 Shifting care — or reducing services?
Matter for discussion submitted by the RCN Northampton Branch
That this meeting of RCN Congress discusses how the care given to older people and the mentally ill is being affected by the move from secondary to primary care
- Work led by the Public Policy Committee
- Lead RCN Council member: Evelyn Nicholls
The ongoing shift of the provision of services closer to people’s homes embraces both the elderly and those who have long term conditions, and since the Congress 2007 discussion, the RCN has been working hard to ensure that services are fit and appropriately staffed for purpose.
The RCN has lobbied hard for ongoing work on the assessment and funding for older people’s services. In mental health services there have been innovations in provision, characterised by a drive to place services closer to where people live, and to end prolonged waits for referral to secondary services, which the RCN has actively supported. The RCN welcomed the October 2007 announcement of increased funding for the Department of Health’s Increased access to psychological therapies (IAPT) programme, and evidence-based interventions will be widely available through an initiative covering over 20 pilot sites.
RCN Northern Ireland is engaging in the impending recruitment campaign by the DHHSPS for mental health nursing, and supporting the work programme of the Banford Review of health and social services. In Wales, the Get it Right campaign has highlighted the need for both additional investment in mental health services and more community nurses. In conjunction with Age Concern Cymru, RCN Wales called for a review of charging for health and social services to older people and the current coalition government has promised to review and develop legislation to create fairer domiciliary care charges.
In Scotland, the government has produced a discussion document, Better health, better care, to which the RCN has responded. A new service model for nursing in the community is currently being tested within four NHS board pilot sites, and RCN Scotland has been involved with the government's dementia forum. Parliamentary inquiries into mental health services, health inequalities and shifting the balance of care are to be conducted by the Scottish Parliament over its current term; calls for initial evidence have been published, and RCN Scotland is discussing our response over the coming months.
Such changes in service provision cannot be delivered without the appropriate workforce and the RCN lobbied hard to illustrate how the wasteful closure of specialist nursing posts impacts negatively upon the clients they serve. The RCN has also been engaged in the Modernising nursing careers initiative, which addresses the nursing workforce required to deliver a changed service configuration. The Post- qualifying framework consultation (led by the Chief Nursing Officer for England) will seek views on the preparation of nurses to work in the community with people with ongoing conditions.