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Transforming community services

Lynn Young
Primary Healthcare Adviser for the RCN

The changes taking place within the NHS are part of an ambitious agenda; but good behaviour and respectful attitudes towards our patients cost nothing

At the end of November 2008 I wrote an article mentioning a momentary lull in the relentless health reform machinery. I spoke far too soon and should have known better, because the NHS in England is now electrified with health changes. These changes are aimed at improving quality of care and ensuring that all patients receive dignified care. Personal dignity will always be respected and protected, and this care will not only be competent and appropriate, but also tailored around personal preferences.
From the beginning of 2009, English health service providers and commissioners will have to begin the long journey towards reaching our destination of world-class transformed community services – hurrah!

Work is now under way exploring community datasets that will actually be useful rather than simply counting widgets (nursing activities and visits); a community quality framework is being developed that will help both commissioners and providers understand better what high-quality services look like, and an action-packed resource pack is being designed to help commissioners do their work.

Never before have I known a time when such energy has been poured into the development of better community services. We need a healthy supply of optimism and a clear vision of how local people can best be served by such services.
Colleagues working in both commissioning and providing tell me what a significant difference clinical pathways are making to both the patient experience and the outcomes of the care they receive.

How remarkable that such a simple system as having agreed care pathways in place that cross all organisational boundaries brings such significant benefits to health and quality of life.
Linked to care pathways is the intense drive to ensure that all people with long-term conditions have their personal care plan which encourages better knowledge, self-care, self-reliance and independence.

Patient power has arrived – not before time – and it is this dynamic that will bring greater quality, dignity and personal preferences to healthcare services above all other measures. The future means less demand on hospitals and the population acknowledging that most of their care will be community based, with easy access to, and mature relationships with, the professionals who work with them.

And here is the critical factor in our journey towards high-quality, dignified and preferred community services: new relationships are emerging between the public and health professionals, which are more about partnership than paternalism and professional snobbery. But we need to do more then build respectful and equal partnerships between individuals. The next task is to encourage patient experience and knowledge to be fed into all levels of commissioning.
Audits are important and therefore must be carried out with diligence and accuracy; but a more challenging task is to ensure that patient stories engage with commissioning in the drive to hike up quality.

Quality, quality, quality; it is all about quality. When we are patients we want safe care wrapped up in quality. No matter how tough our illness, the reassurance that the care we receive is clinically correct as well as kindly, considerate and compassionate is beyond diamonds. It can make the experience more bearable, tolerable and sometimes even interesting, and not necessarily terrible or heartbreaking.

While systems are critical to patient safety, the people who have chosen to embark on careers that involve being close to patients must be expertly selected and well prepared to do the task that lies ahead. They must also be given the support required to ensure that they have the attitude, personal resources and interpersonal skills to care without burnout and emotional exhaustion. The greatest challenge is achieving these worthy endeavours during a time of national financial crisis.