14. General hospitals - what next?
Cambridgeshire Branch
(MFD) That this meeting of RCN Congress has an open and honest debate about the long term future of general hospitals in the UK
Debate report
Many members wanted to have their say on this agenda item about the future of general hospitals proposed by Marcia Turnham, Cambridgeshire Branch. She referred to services being removed from hospitals to specialist centres, along with skilled, specialist staff. Marcia also commented on the fact that overall demand for services has not reduced but the funding to cope is not forthcoming, particularly in community services.
Many members spoke of the emerging dependence on community-based services but that people in rural areas have many miles to travel to access them. Bernadette Medcalf stated that numbers in community nursing are falling but that around one in four 75 year olds are receiving care at home. She spoke of the strain already on these services and that we need “to redress the balance”.
Ann Griffiths, Ceredigion Branch said that people in rural areas are at greater risk than those in urban areas and that general hospitals must remain to ensure the right care is delivered to patients.
Denise Chaffer said the case for change was powerful and that evidence “was bearing out the importance of locality” and that the “standards of care should be the best, with the best outcomes.”
Some members raised the need for nurses to be engaged with the design of services at an early stage so we can influence the shape of services. Nurses were urged to get involved and not wait for it to happen to them.
Maria Nicholson echoed many views that community care needs to be strengthened now and that there is a lack of strategic planning. She said “it’s no good to close wards, for patients to be looked after in the community, when there is not enough capacity to cope”.
The overwhelming messages from this debate were that there is a role for general hospitals; nurses need to be part of strategic planning; and that community nursing needs more investment.
Background
There has been increasing debate over the future of general hospitals, and how and where care should be provided.
Advances in health care treatment mean patients can access care at home or in their communities, and there are calls for more prevention and monitoring services to minimise the costly escalation of patient need and consequent hospital admissions. Research also indicates superior patient outcomes for those who access specialist services, such as treatment centres.
Many believe there are too many general hospitals providing inappropriate and costly care. In England, the increased role of the independent sector adds further weight to questions about how and where to provide health care services, while the patient choice agenda aims to enable greater choice over the type of service patients can access. Meanwhile, the move to foundation trust status has highlighted that some trusts are financially unsustainable. While Payment by Results has identified areas where some trusts could become more efficient or divest; it has also been seen as a barrier to shifting investment to the community.
In 2007 a process of independent scrutiny was set up by the SNP government in Scotland to evaluate significant service change; however, no panel has met formally since 2009. In Northern Ireland, a recent review of health and social care has recommended a reduction in the number of acute hospitals, while in Wales the Welsh Assembly Government has set out its policy to drive a move to services in the community.
The general public has a strong attachment to general hospitals, and closure has become an issue that politicians have opposed locally. Indeed, some groups of patients – such as the elderly – may find changes in provision and how they access care more challenging; people may have to travel further to access care, and this presents potential difficulties for some groups.
Despite the current economic context compounding the need for efficiency, the shift of investment away from acute to community services has not been evident and workforce and education plans have also yet to be adequately developed. This is important, given that the current community workforce is ageing faster than the overall nursing population and there are insufficient numbers of district nurses, school nurses and health visitors in parts of the UK.
The RCN gave oral evidence to the Scottish Parliament Finance Committee on the 2012 budget, and the Committee’s report urged the Scottish Government to lead a public debate on investment/disinvestment options and to develop criteria to support decision making. In response to the review in Northern Ireland, the RCN stated it would support the shift from acute to community provided that nurses are involved from the outset, that the move promotes safe and effective patient care, and is underpinned by appropriate workforce planning and development.
The RCN maintains the nursing workforce must not be cut but must be flexible, and that the current workforce should be supported through training and development to take on new roles, in new settings, to support the acute to community shift.
References and further reading
Imison, C. (2011) Briefing: Reconfiguring hospital services London: Kings Fund Available at: http://www.kingsfund.org.uk/publications/articles/nhs_reconfiguration.html (Accessed 27/02/12) (Web)
Royal College of Nursing (2011) RCN submission to the Review of Health and Social Care London: RCN Available to download (Accessed 27/02/12) (Web).
Scottish Parliament Finance Committee (2011) Report on Scottish Spending Review 2011 and Draft Budget 2012-13: Volume 1: Finance Committee Report Edinburgh: Scottish Parliament (3rd Report, 2011, Session 4) Available at: http://www.scottish.parliament.uk/S4_FinanceCommittee/Reports/fir-11-03-Vol1.pdf (Accessed 27/02/12) (Web)
