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‘Nowhere to turn’ for patients as cuts hit the community

Published: 14 May 2012

Ambitious government plans to move care from acute hospitals to community settings have been branded a ‘facade’ by the Royal College of Nursing (RCN) today, as a survey of community nurses showed that many are facing cutbacks and spending less time with patients.

While the shift from acute hospitals to community care has been given as a justification for NHS posts being lost from hospitals in the past, today’s survey demonstrates that community services are also overburdened, underinvested and at risk from cutbacks. The RCN warned that this risked producing a ‘revolving door’ for patients, who are discharged from hospital only to find that the support is not there in the community.  Many then have to be readmitted to hospital at great expense because support at home is simply unavailable.

The RCN today also released data from the Frontline First campaign showing that more than 61,000 posts are at risk of being slashed across the NHS. Alongside this, the RCN has evidence from official sources showing that 26,327 posts had already gone in the two years to April 2012, demonstrating the weakness of previous pledges to protect the front line.

The RCN survey of community nurses found that fewer than one in ten (6%) said they always had time to meet the needs of their patients, while almost all (89%) said that their caseload had increased over the last year. Nearly six in ten (59%) reported that they were spending less time with their patients than they did a year ago, raising major concerns for the capacity of community services to deal with an increasing number of acutely ill patients.

Dr Peter Carter, Chief Executive & General Secretary of the RCN said:

“Yet again, and despite numerous warnings, NHS organisations are making short-sighted cuts across the UK.  Nurses are being stretched too thin, and many are approaching breaking point. Inevitably, patient care is going to suffer. We are now seeing a clear and worrying picture of a health service which is struggling. It is struggling to keep people out of hospital because of pressures on the community, and it is struggling to discharge them with support when they leave. Very soon, patients will be left with nowhere to turn.

“This is a revolving door for patients, but it also represents a false economy at a time when there is no money to spare. We want care to be delivered closer to home, and we want community nurses to be empowered to keep their patients out of hospital, but at the moment this shift in the way care is delivered is simply a facade, with the community struggling to cope with the workload it has now, let alone the one it faces in the future. This is a harsh reminder that both acute and community care are overloaded and the staffing levels are so low in both that there can be nowhere for patients to turn.”

As well as identifying ongoing pressures on the time spent with patients, three quarters (75%) said that work pressures on their team have increased as a result of social care cuts.  More than two thirds (68%) of the community nurses surveyed said that staffing levels have decreased where they work in the last year, while almost nine out of ten(86%) community nurses surveyed said that patients are being discharged from hospital sooner than before. The RCN is concerned that with these reductions taking place in the community, the NHS is overloading both acute and community care.

While the RCN fully supports the shift from hospital care to community care in the best interests of patients, many nurses raised concerns that vulnerable patients may be being discharged before support from social care is put in place. This can result in patients ‘bouncing back’ between more than one overstretched service.

One nurse described the pressures facing their team: 

“Social care cuts have meant an increase in our workload, as in addition to our nursing role, we are sometimes making patients their meals and sometimes even doing their shopping! You can’t leave someone without food, so what choice do we have? We report it to the Social Work department, but they just say they can’t provide any care at the present time. So sad.”

Another said:

“We are seeing more repeated admissions because of failed social care, and inadequate support. With increasingly complex needs and attempts to keep patients at home, this can mean patients ‘bouncing back’.”

Key examples of heavy job losses across the NHS include:

• NHS Greater Glasgow and Clyde planned a reduction of 402.2 full time equivalent nursing staff over the 2011-2012 financial year
• Sandwell and West Birmingham Hospitals NHS Trust plans to remove 378 posts in 2012, 237 of which are registered nursing posts
• Blackpool Teaching Hospitals NHS Foundation Trust plans to lose 675 staff from 2011 to 2014, which is 16% of its workforce
• South London Healthcare NHS Trust has serious financial problems and has planned to decrease its staffing by 5% each year from 2010 to 2015. Overall this would mean a loss of 23% of staff.
• Imperial College Healthcare NHS Trust plans to cut its nursing, midwifery and health visitor costs by £11.7 million, which represents a quarter of their total savings plan.

Dr Carter added: “Today we are calling on the government and employers to take these stark figures as seriously as we do. Nurses know that patients can’t get the care they need from a fractured health service, and short term decisions could do untold damage to the long term health of our patients.  Parts of the NHS just don’t seem to be talking to each other, and the system needs to work if the NHS is to cope with the challenges ahead.

“When the RCN has exposed posts at risk in the NHS before, we have been attacked by a government which said it didn’t recognise our figures. We would urge the government, as well as employers, to listen to what we, and other respected organisations, are saying and sort this out. The RCN will continue to identify where posts are under threat, and will work both nationally and locally to oppose short sighted cuts that damage patient care.”

Notes for Editors

1. The chart on the following page shows the breakdown of 61,113 posts at risk and posts which have already been lost.

 congress chart

2. Nurses working in the community have a wide range of roles including practice nurses, district nurses and community staff nurses who visit patients in their own homes to treat long term conditions such as diabetes or Parkinson’s, and provide nursing for people who are housebound. There are also mental health nurses who work in the community to manage a variety of mental health problems. Nurses in the community have a crucial role in preventing ill health and can also help people live well and out of hospital with a range of conditions.

3. For more information on the Frontline First campaign, please click here – www.rcn.org.uk/frontlinefirst

4. The RCN surveyed members working in community settings during April 2012. The survey was conducted online and was advertised to members in the field via email. 2,681 members completed the survey.

5. For further information, please contact the RCN Media Office on 020 7647 3633, press.office@rcn.org.uk or visit  http://www.rcn.org.uk/newsevents/media

6. The Royal College of Nursing (RCN) is the voice of nursing across the UK and is the largest professional union of nursing staff in the world. The RCN promotes the interest of nursing staff and patients on a wide range of issues and helps shape healthcare policy by working closely with the UK Government and other national and international institutions, trade unions, professional bodies and voluntary organisations.