Nurses criticise ‘facade’ of moving care away from hospitals

Plans by the Welsh Government to move care from acute hospitals to community settings have been branded a “facade” by the Royal College of Nursing.

The RCN said plans to transfer some services from hospitals into the community were unsatisfactory after a survey of community nurses revealed many are facing cutbacks and spending less time with patients.

The survey found RCN members felt community services were overburdened and under-invested and transferring more services would risk creating a “revolving door” for patients who need to be readmitted to hospital as the right support is not available at home.

Although the RCN said it supported the shift from hospital care to community care in the best interests of patients, they are concerned vulnerable patients may be being discharged before support from social care is put in place.
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Tina Donnelly, director of the RCN in Wales, said: “The RCN fully supports the government’s aim of enabling people to remain at home when appropriate but this aim can only be achieved with the support of a well prepared community nursing workforce.

“While service redesign continues at great pace, RCN Wales wants to ensure that patients are cared for by adequate numbers of nurses and health care support workers who are well educated and well supported by their employing organisations.

“One feature of community nursing is that registered and unregistered nursing staff frequently work alone within people’s homes. This isolated way of working must be supported by strong systems of leadership and supervision and the RCN Wales urges the Welsh Government to ensure that patient safety is at the heart of workforce planning.

“We are also calling on the Welsh Government to ensure the number of registered nurses working in the community is increased and an appropriate ratio between registered nurses and health care support workers is maintained.”

The survey found 89% of community nurses said their caseload had increased over the last year and 59% reported they were spending less time with their patients than they did a year ago.

One district nurse who responded to the survey said: “My team has lost a total of 166.5 hours per week after losing staff nurses who have not and are not being replaced.

“This has a tremendous impact on services and I personally feel that it can lead to unsafe practice for patients plus burn out of existing staff.

“This is particularly so at weekends where one staff nurse will be expected to cover a huge geographical rural areas. Not only will this put more stress on nursing staff but could even be dangerous having to drive from one end of the area to the other to attend to patients. It could even lead to unsafe practice due to having to hurry tasks in order to meet targets.”

Dr Peter Carter, chief executive and general secretary of the RCN said: “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.”

The Welsh Government said they would work with the RCN to provide the best care for patients.

A spokesman said: “We will consider the findings to see what specific issues apply and what action needs to be taken.

“The Welsh Government has a strong relationship with the RCN and we continue to work closely with them in the reconfiguration needed to appropriately place services and bring care close to patients’ homes.”