Effective community services are crucial, according to NHS bosses, to the success of proposals to reconfigure Leicester’s hospital service. (City’s £450M Care Package, Sep 28 ’20)
In the consultation documentation there is frequent reference to work in a community setting but no details are given or justification for changing the clinical pathways so that more patient care will take place in community settings.
The NHS says that an expansion in community services, including treatment at home, will compensate for the rising need for hospital beds. There are no plans to expand the number of hospital beds after 2024 despite large population growth projected for the city and county in the coming decades.
Community care can include home support, nursing, physiotherapy and other services to keep people well and avoid the need for hospital care. At present there are insufficient community services due years of austerity.
There are no details either on workload of specified GP practices, urgent care centres, clinics and community hospitals, how many extra staff will be needed to provide this care, how much this extra care in community settings will cost and how much additional funding will be made to community services to provide this care.
The NHS and other policy-makers say that moving care out of hospital will deliver the ‘triple aim’ of improving population health and the quality of patient care, while reducing costs.
Community care may not be a ‘magic bullet.’ Research suggests that rather than improving patient care it will be damaging to patients. The cost of staff and other resources also in the community can out-weigh the savings from the hospital care avoided. (Nuffield Trust, March 2017)
The absence of detailed information on community care suggests the implications of the plans have not been fully costed and that the full costs of this emphasis on new build and asset disposal (most of the land and buildings at the General Hospital) in preference to a refurbishment are unknown or hidden.