ONE patient developed pressure sores because social care staff weren't coming in frequently enough to move him; another had meals made and shopping done by a nurse because the local social work department couldn't provide anyone else to do it: anecdotes such as these from community nurses do not paint a promising picture of how Scotland might function with more community-based health and social care.
The Royal College of Nursing (RCN) Scotland's survey into the state of community nursing, certainly gives pause for thought. At a time when a drive is under way to deliver more care to people in their own homes instead of in hospitals and nursing homes, nearly two thirds of community nurses said that in their experience, staffing had decreased in the last year, while more than three-quarters said their caseload had increased.
The Scottish Government disputes the findings, insisting there are 2400 more nurses working in communities now than six years ago, but the fact remains, community nurses are stating loud and clear they are overburdened bytheir workload a situation not helped by having in some cases to cover tasks that should be carried out by social care staff.
The basic principle of providing more community-based care for the benefit of patients, is sound, but the problems being encountered by nurses highlight the disconnnect between aspiration and reality at a time of economic stringency. Cuts to social care budgets, over which nursing staff and their managers have no control, are directly impacting on the work of community nurses. Only with adequate numbers of both community nurses and social care staff can community-based care be properly delivered. It also highlights the importance of closer working between health boards and social work departments, at a time when the Scottish Government is promoting greater integration of health and social care.
Right now, in Highland region, a major, pioneering experiment is taking place that could come to define how adult health and social care is delivered in Scotland in future. Around 1700 social work and social care staff previously employed by Highland Council have become the employees of NHS Highland, while 250 former health board employees, including school nurses and health visitors, are now working for the council. The move represents the integration of adult health and social care under the auspices of NHS Highland, and child and young people's health and social care under the council. In the view of its champions, it is a great improvement on the pre-existing partnership model, in which one side could veto much-needed changes to how services were delivered.
There is no doubt much to be gained from greater integration, both in Highland and across Scotland. With one body responsible for delivering both nursing and social care to a patient, problems such as those encountered by community nurses should, in theory, become easier to solve.
Reorganisation, however, is not a substitute for proper funding, even if the integration process itself delivers efficiencies. If the Scottish Government's vision of happier patients cared for at home is to become a reality, greater investment in community nursing will be a necessity.
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