24. Putting money where it's needed
East Dorset Branch
(R) That this meeting of RCN Congress asks RCN Council to lobby for financial resources to precede or accompany the patient so that their needs are met regardless of location
Result
The resolution was passed.
For: 375 (97.19%)
Against: 8 (2.09%)
Abstain: 15
Debate report
With a shift from acute environment care to that in the community, how can we ensure that funding goes to the right area at the right time, to ensure patient care is not compromised?
Lisa Crooks, seconder from the Gloucester Branch, said that it is essential for service delivery, as well as funding, to be consistent too for successful continuing care.
Those speaking against the resolution highlighted the need to consider more than funding and wanted a wider debate about equality in care.
There was widespread agreement throughout the auditorium that community services desperately needed investment; with the overwhelming message being: “please invest in our district nurses”.
Background
Shifting care from the acute sector to the community has been an ambition in the NHS, across England, Scotland, Wales and Northern Ireland for some time, but never more so than in these times of financial constraint. The requirement to deliver quality services, meet rising health and social needs and simultaneously tackle debt has led to a renewed focus on the shift of care to the community as a means of delivering higher quality care at a lower cost. This will mean fewer beds in hospitals and more patients, some of whom will be acutely ill, being cared for in the community.
There is concern, however, that community services have not seen a sufficient increase in resources to cope with demand. The potential impact of this on patients and staff is less than optimum care, an increase in preventable admissions, delayed discharges, increased waiting lists for community services and increased reliance on informal carers.
The move to care delivery in the community is set against the backdrop of care funding within the UK. In England there are two main approaches in use. With Payments by Results, payment is activity-based (hospitals get paid for the care they deliver to each patient) and the ‘money follows the patient’, as patients can choose where to go for their elective surgery. By contrast, under block contract schemes (which include community care) a set amount of funding is agreed between the commissioner and the provider for the delivery of certain services; in effect the ‘money does not follow the patient’.
In the rest of the UK, there are variations on per capita funding and block contracts, underpinned by local discussion and agreement on services to be provided. At present, Scotland is reviewing how funds are allocated across services and client groups and exploring more integrated budgets across health and social care. In Northern Ireland the current concern is ensuring careful planning takes place in relation to the practical steps needed to bring about the shift from acute to community care.
The RCN is supportive of person-centred care, which includes ensuring that care is located where it can best meet the individual’s needs. Moving care from the acute sector will require investment in the community, and support for staff. It may also require the ‘double’ running of services during transition to avoid care gaps. At the present time the RCN in Wales is working with the Welsh Government, measuring acuity in the community and how this information can be used to inform staffing.
References and further reading
Royal College of Nursing Northern Ireland (2011) RCN submits evidence to Review of Health and Social Care London: RCN Available to download (Accessed 27/02/12) (Web)
Royal College of Nursing Policy and International Department (2011) Price and competition in health care in England London: RCN (Policy Briefing 2/11) Available to download (Accessed 27/02/12) (Web)
Welsh Government (2010) A community nursing strategy for Wales Cardiff: Welsh Government Available to download (Accessed 27/02/12) (Web)
