Medical treatments that were once provided in hospital are being increasingly administered in the community. Within health systems, there is a renewed focus on delivering general health care in the community, freeing hospitals to provide more complex, specialised and emergency care. As the drive to shift specialised and non-specialised care out of hospital gathers momentum, there is a greater demand for a skilled and competent community nursing workforce to facilitate this shift at a local level. Nurses are essential in the delivery of continuous care as they often serve as an interface between acute and community care, focusing on prevention, self- management and providing support to transition patients smoothly across the health and social care services.
Moving care to the community has been a UK-wide health and social care policy priority for more than a decade. However, progress has been slow and in some cases fragmented. In order to address the issue, it is important to first review where this shift has been implemented and which lessons can be learned from international experiences. The RCN is committed to working closely with its equivalent nursing organisations overseas to learn from international best practices and incorporate some of this learning to shape health and social care policy in the UK, and more specifically promote good nursing practice.
This report will focus on system-wide or sector specific reforms in Australia, Canada, Sweden, Norway and Denmark as these countries have at one point or another addressed the need todeliver care outside of hospitals, either in patients' homes, GP clinics, community-basedcentres or care home settings.
- Internationally, despite variations in policy reforms and health incentives, the rationale for moving selected hospital services to the community has been fairly consistent across countries.
- To effectively shift care out of hospitals and re-provide these services in the community, a whole-system approach is needed. Hospital restructuring cannot happen in isolation but must go hand-in-hand with reinvestment strategies. Otherwise, there is a possibility of creating a transition gap in service provision.
- Internationally, there is much focus on integration and co-ordinated care as a means to improve continuity, reduce fragmentation within the health and social care systems and deliver good patient outcomes. Nurses play a pivotal role in supporting and promoting better coordinated care. Where integrated care models have been successful, there is evidence to show that close collaboration between local authorities, commissioners, service providers and frontline staff have been instrumental in that success.