Hospital care at home? Are you sure that’s what is best?

“… In community health nursing, there has been a 12% drop overall in full-time equivalent staffing numbers since September 2009, despite growing demand.

In the East Midlands, district nurse Mary Black says her team and other colleagues are struggling to cope, because of a mixture of unfilled vacancies, maternity leave and long-term sickness absence, which directly affect patient care. “We firefight every single day: moving patient visits, ringing round to see if other teams can help, and we often have to cancel or defer. We have bank and agency nurses to cover vacancies, but not usually sickness or maternity leave, so it means the staff who are left have lots more visits to do each day,” she says. “There is no continuity, as often there’s a different agency nurse each day and there are a lot of duties and patient visits that an agency nurse can’t do, so the complex patients fall to our permanent members of the team. Agency staff often cancel at the last minute and sometimes don’t turn up.”

Black says: “It often feels like we’re not giving our patients a very good service, we cannot spend the time with them that they often need. Incidents and complaints will have risen.”

Last month’s report on the public sector workforce by the Reform thinktank is blunt about the impact of staffing problems. “Public services fail when employees fail,” it concludes. “This is the dramatic lesson from a number of high-profile errors in recent public service delivery. In many instances, quality is compromised, not because of individual incompetence, but the way the workforce is structured and organised. …

… “When you don’t have the right staff levels, we have to see patients on a prioritised basis,” he says. “Patients don’t get the quality and sometimes it means people get sub-optimal outcomes. It’s frustrating and demoralising.” Some of his colleagues have voted with their feet: leaving for private sector jobs with better work-life balance, or moving somewhere with lower house prices. “They are on the same money as it’s nationally done but the property prices are different,” Davies says. In the South-West, the shortages are particularly acute for more junior grades. “It tends to be easier to recruit more senior physios as they are a band up so the pay is better but it still can be an issue getting the right people down to us.”

One thought on “Hospital care at home? Are you sure that’s what is best?

  1. The CCG did NOT publish all the clinical evidence supporting “hospital at home” as required by the government, and that which they did publish was after the consultation had closed and was at best neutral about whether there were benefits or not – though negative about the possible risks.

    They have not explained why the remaining evidence was not published – but it is reasonable to assume that it was because it is detrimental to the “hospital at home” proposals.

    So don’t be fooled – these changes are likely to be massively detrimental to patient care and it is likely that (in addition to the 150 avoidable deaths PER WEEK at present as admitted by Jeremy Hunt – that’s more than 7,500 deaths per year BTW) we will get a shed-load more avoidable deaths under “hospital at home”. My guesstimate is that this could be up to 750,000 avoidable deaths per year – yes three quarters of a million avoidable deaths per year.


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