Continuing their overarching theme ‘Our Nurses. Our Future’, the International Council of Nurses (ICN) has chosen to focus International Nurses Day 2024 on the economic power of care hoping to reshape perceptions and demonstrate how strategic investment in nursing can bring economic and societal benefits.
This builds on the ICN Charter for Change report launched on International Nurses Day 2023 which set out a series of commitments for governments and policy makers.
QNIS has invited its Fellows to reflect on these policy actions and share their thoughts about the economic power of community nursing care.
© Lesley Martin 2022
The first blog in this series comes from Dr Linda Pollock, QNIS Fellow, Former QNIS Vice Chair and hugely experienced community nursing leader. Linda has held strategic Nurse Director roles in primary and community care. In this blog, Linda is focusing on Policy action number seven which states:
“Recognize and value nurses’ skills, knowledge, attributes and expertise. Respect and promote nurses’ roles as health professionals, scientists, researchers, educators and leaders. Involve nurses in decision-making affecting health care at all levels. Promote and invest in an equitable culture that respects the nursing profession as leading contributors to high quality health systems.”
#IND2024
#OurNursesOurFuture
It does not take a financial genius to work out the economic impact of community nursing. A brief review of the research literature and patient/carer feedback studies demonstrates the benefits and the quality of care delivered by community nurses. Such effort would confirm that Community Nurses are good value, efficient, and cost effective. Set against these findings, many Audit Scotland Reports, year after year, show that community services within the NHS in Scotland are grossly underfunded – increasingly so – and, despite the political rhetoric to develop community care, the ‘Cinderella Services’ (everything other than acute hospitals services), remain poorer and demonstrably inadequately resourced.
More than 1 in 6 patients in Acute Hospitals across Scotland have been treated and are waiting either for care packages to go home, or for places in a nursing home, yet the Scottish Government does not collect statistics on these waiting times, and there is no programme to develop these community services. Nor are data collected on the waiting times to be seen by a GP. Government targets are just NOT community orientated. What gets measured gets done and, given that the political masters are interested in acute service targets, by implication that is what gets funded. The cumulative effect of this ‘acute focus’ on such statistics is that community services loose out.
It costs £1000 to keep a patient in hospital for a night compared with £100 at home. Just imagine if the bed costs of patients trapped in acute hospital were available instead to community nursing to develop care packages to keep people at home – exactly what most families want? In addition to being a cheaper solution for the Health Boards, it would release bed capacity to help deal with the increased demands for NHS hospital care which we hear about so often in the media. More community nurses could also be employed in care homes to ensure clinical quality there.
The hospital beds of course will get filled up quickly, by other ill patients, but the number of people in blocked beds gives an idea about what sort of investment is needed to get the system moving, to develop care in the community and deliver a service the public want. This is what is described in the jargon as ‘invest to save’ and that requires a long- term view of the contribution of community nurses.
The NHS is being eroded, slowly but surely, and needs to be simplified and redesigned. We need to focus more on what patients and carers want, and build a better NHS available, first and foremost, at community level. This all makes economic sense!
The NHS has become a reactive sickness service yet only 20% of our health is determined by medical interventions – the vast majority is driven by wider social factors (diet, smoking, housing, alcohol, education, poverty and working conditions).
Community Nurses are perceived by patients as working in partnership with them and their families, and they are well placed to deliver interventions aimed at improving health. They have access to the public in the workplace, schools and in the home. Additionally, they have contact with many client groups, and importantly, with groups who usually have little contact with health professionals e.g. adolescents and healthy adults, especially men. Home visiting gives community nursing a unique opportunity to intervene with vulnerable groups e.g. babies and children, women during pregnancy and the post-natal period, and the elderly; their experience of working within primary care teams and in partnership with community groups allows them uniquely to target inequalities by working with at risk and minority ethnic groups and with challenging social issues like domestic violence, and problems linked with obesity, drugs, alcohol and mental health.
As part of Scotland’s policy drive to implement “Nursing for Health”, a review of the literature was undertaken which uncovered a wealth of evidence on successful interventions carried out by community nurses. Criteria for effectiveness of community nursing interventions were identified although the costs or ‘value for money’ were seldom assessed. What was clear though is that many behaviour changes require long term input to achieve and sustain health gains. Apparently between a quarter and a third of people in hospital need never be there, if they were diagnosed and treated early enough, and 1 in 5 general hospital admissions could be prevented. These statistics can be modelled financially, and it makes sense surely for current Health Boards to invest to save, and long term, have community nurses working on preventative measures to reduce hospital admissions. Political targets should focus on keeping people healthy not just treating them when they are sick. Community nurses have a crucial part to play here, and historically they have carried out innovative projects, especially in deprived communities across Scotland – areas which Health Boards long ago, stopped funding.
Since 2006, community nurses and pharmacists have been able to train as independent prescribers and they should be doing this widely, especially given that two thirds of medicines-related admissions to hospitals are preventable. Significant savings could be made by reducing wastage and ensuring medicines optimisation, and importantly, community nurses could take workload off GPs by dealing with repeat prescriptions and actively managing patients with chronic diseases.
There is no doubt that Community Care is more rhetoric than reality, and Health & Social Care continue to work in parallel. More investment is needed in community – I thought this would happen given the COVID lockdown clapping that took place weekly indicating support of the NHS.
Concerted effort is needed to stop community nurses leaving the NHS at 55 – too early – they are haemorrhaging out of the NHS – a sign they are unhappy not just over-worked. From speaking to them, it’s also due to managers carrying out government policy without listening to community nurses about the long-term implications of decisions on staff, patients, and carers. We need to be shouting about this to our MSPs and challenge them about what they are doing with OUR money.
The NHS is being eroded, slowly but surely, and needs to be simplified and redesigned. We need to focus more on what patients and carers want, and build a better NHS available, first and foremost, at community level. This all makes economic sense!
