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RCN slams Government plans for acute care

Nurses have branded the Government’s plans to move care from acute hospitals to community settings a ‘facade’, 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, the survey published on Monday by the Royal College of Nursing (RCN) demonstrates that community services are also overburdened, underinvested and at risk from cutbacks.

The RCNwarned 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 at the same time 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 RCNsurvey 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 thatpatients 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.”