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Over 300 nurses, allied health professionals and other stakeholders gathered in London on 29 September to hear and question a range of speakers on the future of community health services.
NHS England Chief Executive Simon Stevens (pictured above with Kate Billingham) chose the event to launch the latest NHS Innovation Fund, calling on nurses to apply for a share of the £650,000 available. For more information go to: www.england.nhs.uk/2014/09/29/innovation-nursing/
Dr Michael Dixon spoke of a range of issues from the perspective of the primary healthcare team.
He spoke of the need to ‘demedicalise’ healthcare provision – as part of the necessity to promote healthier lifestyles and better population health. He said that communities must take more responsibility for their own health.
He said that however his practice in Devon was under increased strain – with twice as many over 75s, and twice as many patients with dementia. He feared that primary healthcare had become the ‘ugly duckling’ of the NHS, after years of lack of investment.
He said that the District Nurses need to be re-empowered to be the general ‘fixers’ of community healthcare. He said that their role, as the lynch pin between health and social services, was ‘almost a commissioning role’.
He outlined five different models of healthcare planning and service delivery. He urged community nurses to ‘make sure you have your say’ in redesigning how services were provided. Otherwise he feared a ‘breakdown in the relationship between patient and clinician’.
He envisaged a future with greater use of ‘social prescribing’ if we are to avoid a million operations for gastric bands, and a whole population on statins.
Ellen Armistead highlighted that the work of the Productive Community Series showed that around 21% of a community nurses time is spent in face to face patient contact time. Trusts must work to ensure they do all they can to increase the amount of patient facing time. Ellen also urged all nurse leaders to address their “worry wards/services” to ensure systems and processes are in place to take action with chronically underperforming services and ensure complacency to these areas is not a factor.
A former District Nurse, Ms Holt said that her experience in the community is of considerable help in her current strategic role. She illustrated her talk with the experience of patients she had encountered.
She recalled the days of her frontline practice, where a patient with breast cancer was discharged home without knowing what her prognosis was which was normal practice at the time. There was a fear of giving bad news.
Nowadays relatives live further away, and some people such as asylum seekers have little or no social support at all – hence for many people they have far less family support than in previous generations. She stated that social isolation is extremely harmful.
She also spoke of the risk of developing pressure ulcers among some newly discharged patients, which is often underestimated by those nurses responsible for the discharge. She also spoke of the new systems in place for patients with an indwelling urinary catheter which is transforming the quality of patients’ lives and reducing inpatient costs.
North East London Foundation Trust (NELFT) have worked with commissioners to deliver a community treatment team in hospital whose aim is to prevent hospital admissions -particularly for the elderly. They also have a community arm who can provide rehabilitation support in the clients home. Dame Donna noted that acute hospitals are discharging sicker and sicker people.
The hospital where she works is seeing double the number of people that it was built for. 21% of those are over 65. They also have big problems in recruiting staff. For all these reasons and more, it is a struggle to process new admissions within the mandated 4 hours. In this environment, older unwell people can deteriorate fast.
Hospital is not always the best place for them to be. In her experience, there is often a lack of imagination however about how people can be prevented from admission – and instead supported to remain at home.
Donna gave one example of a patient with learning disabilities who needed intravenous antibiotics, and for whom special arrangements were made – against initial expectations – for community nursing services to give her the antibiotics at home.
She also explained how it was necessary to split the tariff in order fund specific areas of work – for example for District Nurses to give care to patients with cancer discharged from hospital.
She concluded in stating that chronic disease management needs community nurses.
Professor Bennett spoke about the need for more personalised public health and how nurses and especially community nurses have roles responsibilities and skills in ‘personalised care and population health’. She illustrated the talk by discussing the health needs of people who are homeless and the nursing contribution to both individual health care and improving the very poor health outcomes for this whole population of people.
She praised the work of QNI Homeless Network and discussed the national’ Personalised care and Population health’ Programme. She introduced a resource for nurses midwives and AHPs to provide evidence and information for practice and improve the visibility of the nursing contribution to population health improvement. It can be accessed at this link: https://www.gov.uk/government/publications/framework-for-personalised-care-and-population-health
Ms Nicholson spoke about carers, in particular young carers who support millions of people in their own homes. Community nurses have the ability to have a huge impact on the work of carers – making life better for them and the people they care for.
She also pointed out the social stigma attached to young carers, which can lead to stress and behavioural problems, and may contribute to them being bullied at school.
The QNI and the DH are currently working together closely to improve the support that community nurses can give to carers.
Mr Stevens said that the relationship between primary and secondary care was out of balance. Large investments over the previous decade to lower waiting times for operations such as hip replacements had been successful, but had necessitated expansion in secondary care. He said that everyday admissions of under 2 days stay in hospital had increased by 124%, of which, only 7% could be attributed to an ageing population. This suggests that at least some of the admissions could be prevented with stronger primary and community and social care.
He spoke of a recent visit to northeast London, where he saw services that were not integrated, where there was fragmentation, and people ending up in the wrong silos of care. He said that it would take 3-5 years for remedies to these kinds of problems to be effective.
He also believes that mental health has been overlooked. He said that in looking at the NHS, we must ‘think like a patient and act like a taxpayer’.
He also noted that there are more unpaid carers in the UK than there are NHS employees, and that we cannot do without them, so they need much better support.
He also chose the conference to announce the NHS Innovation Awards 2014, for which £650,000 is available to improve patient care – in areas such as diabetes, infection control, and new technology. He encouraged community nurses to apply. More information is available at:
Please use the Twitter hashtag #qni2014 to enable you to see some of the questions that nurse delegates put to Simon Stevens.
Click here to view all of the conference photographs. If you choose to publish any of these, please credit Kate Stanworth/QNI.