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Keeping it in the community

As we enter another year of financial insecurity for the NHS, we must continue to fight for our community nurses.

The year 2012 is destined to be a challenging but also exciting one. My goodness, what with the London Olympics and the Queen's Diamond Jubilee, we are heading for party time - even if you are not an ardent Royalist or enthusiastic athlete. After all, there is always the synchronised swimming event to get excited about!

On the other hand, 2012 is also the year when financial cuts will be sorely felt across the nation. From the welfare state, to education, all parts of the public sector and of course, nearer to home, our beloved NHS, less money is the name of the game.

Looking back over the last decade it seems incredulous to recall the huge sums of cash sloshing around the NHS during the days of Blair and Brown. Waiting times were slashed throughout the UK, National Service Frameworks transformed care, General Practice became rich overnight and there was more of practically everything - apart from district nursing and health visiting services. Somehow during the time of NHS feasting these two essential services diminished in size, with a steady decrease in the number of health visitors and district nurses.

In England, genuine attempts are now being made to increase the number of health visitors by 4000 - please look out for the regional health visitor workshops coming your way. But sadly we cannot acknowledge that similar attempts are being made to rebuild the district nursing workforce, with the result that in far too many areas district nurses are running ragged in order to keep up with demand. This is a dire situation, particularly in light of nursing needs in the community continuing to rise rather then decreasing.   

The call is out for more people to be nursed at home rather than in their local hospital or care home. While this, for many reasons, makes inordinate sense and is requested by people, there is little hope in achieving community nursing for all, without a fit and able workforce or the resources enabling it to meet growing demand.

Many of us will look back over the years and wonder how on earth the number of district nurses working in England decreased from 14,000 to less than 10,000 in a decade.

Hindsight is an amazing thing, after all; some of us have a PhD in it! But, there is little doubt that while all attention was focussed on eliminating waiting times, meeting targets and productivity challenges the eye was definitely off the development of the community nursing workforce. Nurses, their colleagues and the public are now paying the price for such lack of attention by those who have responsibility for workforce planning and development.

Urgent and substantial action is now required if people who wish to be nursed well at home are to have their preferences met - during a time of financial austerity to boot!

But this can be done if the right people have the skill, determination and courage to make unpopular decisions and then the tenacity to carry them out. The only way, though, for the community to become stronger is for money to be released from the hospitals and transferred to it  - an ambition voiced way back by Nye Bevan right at the beginning of the NHS in 1948. So many health ministers since this time have also called for the NHS to be less captivated by hospitals and more focussed on the prevention of illness and the provision of wonderful care in the community. Time will tell if the coalition government is to succeed in this mission where previous administrations have failed.

The nursing profession has its part to play and must ensure that modern nurses are equipped to be competent in the community on qualification, and thereafter have access to post-registration programmes, thus enabling  community nurse leadership to flourish.

So here we go again. Nurses need to keep their eye on the ball, enjoy the year's celebrations, and be nice to each other when the going gets tough in the workplace.