22. Acute to community – can we do it? (matter for discussion)

Cumbria Branch

That this meeting of RCN Congress discusses whether nursing staff have sufficient training and support to make the transition from an acute to a community setting.

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Progress report

Council Committee: NPPC
Committee decision: Integrate into current workstream
Council member/other member/stakeholder involvement: Lors Allford, Ann Griffiths, Susan Fern
Staff contact: betty.kershaw@rcn.org.uk

This matter for discussion was incorporated into Future Nurse, Future Workforce. The RCN Nursing Department Education Adviser was already working with colleagues and external stakeholders to address this issue and this work continues.

Over 40 stakeholders attended a meeting at RCN HQ on 6 September 2010 to address all aspects of community care, including this issue. Attendees included commissioners, educators (including Council of Deans), managers, members, Council members and RCN officers, and the discussion was wide ranging. A paper reflecting the meeting was shared with people who attended the event and was used to help inform the RCN response to the White Paper (England), Liberating the NHS – developing the workforce.

In August 2010 the RCN published its document, ‘Pillars of the community’ which describes a framework for developing community nursing practice and the workforce which applies to the four countries. Since then an RCN paper on health visiting has also been developed and a further paper is being discussed.

In Northern Ireland, Scotland, Wales and England the administrations have workstreams which relate to the future provision of nursing in the community.

The NMC has announced that it intends to undertake a review of the specialist community nursing programmes.

In England the RCN is working closely with the DH on its new Health Visiting Programme which aims to develop a further 4,200 health visitors.

Debate report

Karen Dutton from the Cumbria branch asked Congress delegates to consider whether nursing staff have sufficient training and support to make the transition from an acute to a community setting. She recognised the need for high quality care for patients close to their home but highlighted the pressures this could bring to nursing staff. Citing the recent floods in Cumbria when whole communities were cut off, she asked for rural communities to be given special consideration.  She said that nurses were able to embrace change but needed support when they may be in a situation where their job descriptions could be completely rewritten due to the change in the services they were expected to provide. Proper training and support is key - "the money must follow the nurses," she said.

Lee Derham highlighted that community nurses work in a different way. The lack of immediate second opinion meant that this group of staff need to actively seek support which should be on the end of the phone, she said, as she highlighted the dangers of downgrading supervision for these health care staff.

Patient safety was a key issue for Wendy Fairhurst who told delegates that it was essential that nurses were at the commissioning table to ensure that appropriate education and support were maintained. An example of nurses getting involved and working with the commissioners was given by Helen Brown who said that this worked because nurses were vocal and made their voice heard.

Denise Chaffer said that it was essential that the funding for staff wasn't lost and this was backed by Gail Brooks who urged RCN activists to 'get their voice heard' by ensuring that staff training remained on the Staff Side agenda.

Background

The four countries of the UK have all set out their visions for commissioning/planning and providing care outside the hospital setting and in the community. Commissioners/planners are already reconfiguring services to support re-designed patient pathways in local settings by skilled practitioners.

Initially emphasis was placed on the development of new roles for GPs, but it is clear that other clinicians could also develop new roles. Work being undertaken by the chief nursing officers will provide the frameworks for the role of the nurse in the planning and delivery of care in community settings in England, Scotland, Wales and Northern Ireland.

Although the role of the specialist nurse has been acknowledged and some guidance is available, many nurses and other members of acute hospital health care teams are moving into primary care settings and there is little acknowledgement that, while some skills are transferable, there is likely to be a skills deficit. The RCN Education Forum has explored the learning needs that could be supported by universities and has identified a knowledge deficit.

Nursing teams need to identify their own additional learning needs including the management and education support they will require to enable them to move to new areas of practice and confidently continue to deliver quality care.

Furthermore, staff will need to be supported to change role, ensuring they remain in the same level post and have access to the same opportunities for training and career development as before. The RCN will also need to ensure that retraining costs are not passed to nurses and that NHS managers support nurses with the retraining that ensures they meet NMC competence standards for safe practice.

References and further reading
Department of Health (2006) Modernising nursing careers – setting the direction, London: DH.

Department of Health (2008) Transforming community services.
Our health, our care our say: a new direction for community services, London: DH.

Parliament (2009) Health and Social Care (Reform) Act (Northern Ireland) 2009, Belfast: TSO.

Royal College of Nursing (2010) RCN Scotland's vision for community nursing in Scotland.
www.rcn.org.uk/aboutus/scotland/community_nursing_in_scotland

Welsh Assembly Government (2009) A community nursing strategy for Wales: consultation document, Cardiff: WAG.
www.rcn.org.uk/__data/assets/pdf_file/0003/248286/WAG_consultation_doc.pdf