The principle of providing more care in patients' homes rather than hospitals is a good one.
Nurses working in the community rather than on wards can spot and treat patients who might otherwise end up visiting A&E. There is also a growing body of research showing that, in some cases, treating a patient at home rather than in hospital can improve their care and that patients are often happier with such an arrangement. Community-based care also helps to free up beds at a time when hospital and care services are under considerable strain.
However, none of this theory is of any use unless the community nurses who have to make it work get the support and resources they need; staffing levels also have to be sufficient to meet the needs of their patients. On whether these standards are being reached, there is a division of opinion. The Scottish Government says there are more nurses working in the community than there were before it came to power while most of the nurses who took part in a survey for The Royal College of Nursing Scotland disagreed that more community staff were being employed. Whichever is true, the RCN Scotland survey appears to show community nurses are feeling the strain. Any workplace survey is likely to raise complaints about workload, but the feedback from the nurses is clear: their caseloads are increasing; their time with patients is being cut, and they are far too busy to provide the kind of care they would like to.
These issues will have to be addressed if the drive to deliver more care in homes rather than hospitals is to be delivered effectively. The community nurses will also have to be given the funding they need to provide the service that is expected of them. What's more, the pressure on the service is only likely to get worse, not better, as the Scottish population gets older and frailer (there is evidence that this factor is already making community nurses' jobs harder).
The Scottish Government's response so far has been to say that patient satisfaction is high (it claim the vast majority of patients believe they have enough time with a nurse). In the face of that, however, we have the evidence of what community nurses have been telling us for several years (only last year two thirds of them said that staffing levels had decreased).
Somewhere in the system, there is a disconnect between the principle and the practice and it needs fixing. The principle of happier patients treated at home is fine. But the practice is not living up to that ideal, particularly if, as the RCN survey indicates, there are still cases of patients being sent to hospitals when they could have been treated by a community nurse instead.
As part of our Time for Action campaign, The Herald is calling for a review of the capacity in hospitals and in the community to ensure the system gets staff to the right place at the right time to look after patients. Community nurses are a critical part of such a system, but greater investment will be needed to ensure they can play their part.
We moderate all comments on HeraldScotland on either a pre-moderated or post-moderated basis. If you're a relatively new user then your comments will be reviewed before publication and if we know you well and trust you then your comments will be subject to moderation only if other users or the moderators believe you've broken the rules, which are available here.
Moderation is undertaken full-time 9am-6pm on weekdays, and on a part-time basis outwith those hours. Please be patient if your posts are not approved instantly.