Discuss How Care In The Community, May Enhance Care Given To A Client Group Within The Community

Discuss how community nursing may enhance care given to a client group within the community. Community nursing is taken on by many health professionals. It encompasses the area which a patient is to be nursed in as well as the type of care which can be received. In discussion of this community needs to defined in the aspect of care and in nursing. Legislation about the discharge planning, financial support and the carers’ role and future goals within these areas. The client group to be discussed along side this topic is palliative care, the patients, health professionals and how this extends from hospital and into the community.

The concept of community is not definitive, there is no single definition and the dictionary simply refers to it as: �a body of people living in one district.’ However, this can be the area we live or the religious, cultural group we belong to (Collins gem, 2001).

For the purposes of this assignment community encompasses all of these aspects and the care provided outside of the hospital setting. Community care is highlighted as the way forward within the healthcare service. The Department of health and social services for Northern Ireland has a strategic vision to enable people to live independent lives, within their own homes. Caring for people beyond tomorrow Primary health and social care: A strategic framework for individuals, families and communities (DHSSPS, 2005), has proposed a vision for the next five years and looks at primary health and social care. Its goal is defined in four high level goals encompassing accessible services, effective partnerships, and better communication and an infrastructure providing integrated modern services. They believe that by 2025 these core values are achievable; empowerment, respect, partnership, excellence, community, safety, continuity, value for money and equity (www.dhsspsni.gov.uk, 2005).

Community profiling (Investing for health, 2004) enables specific needs to be identified within an area. It looks at changes in employment, housing transport, health environment and crime. Statistics are gathered from government, health promotion and community steering groups. This enables a target to be set within these particular communities and changes to be made to enhance particular areas of need. Deprived areas have been found to have higher health risks due to poor diet, higher incidence of smoking and alcohol intake, lack of employment and poor housing conditions (Department of Health, Choosing health, 2004).Changes to these areas can be made through health promotion, improving housing conditions, and education. Community profiling along with the new primary health and social care vision, should enable community services to be improved and a smoother transition from hospital to home.

Legislation over recent years has enabled community care to be enhanced and services improved. The first piece of legislation published in 1990, the NHS and Community care act, outlines the new NHS trust’s polices and community care provisions, highlighting the need for assessment of patients within the community, seven years later it was followed by a white paper, New NHS, modern, dependable, 1997. (www.dh.gov.uk) this highlighted major changes within the NHS, focusing on the needs of patients and the launch of �integrated care’. It centres on; care provisions at home and better resources for health and illness advice and information. Better community care in local surgeries and health centres and quicker hospital care and discharges.

Following that a white paper was produced to focus on the healthcare workforce, making a difference, 1999 looked at nurses, midwives and health visitors, establishing changes in training, extending job opportunities and a pay rise. This was all to enable the modernisation of the NHS to provide a better service.

All of this legislation aimed at putting more health services into the community; however more pressure is put on the families of patients leaving hospital too early. You can take him home now- carers experience of hospital discharge (2001) www.carersni.org raises this issue. These carers felt that the people they look after were sent home to early, and that they were not consulted or involved in discharge despite former legislation stating that the patient and their family should be aware of the reason they are in hospital, the care they receive and discharge arrangements. According to this report only 1 in 4 carers were given the choice in whether they wanted to undertake the caring role, 17% reported that the patient was sent home at the wrong time, 33% were not consulted prior to discharge, 6 out of 10 had their needs assessed, 61% reported that not enough support was provided on discharge and 17% of patients returned to hospital within 2 months of discharge. However estimates of 5.7 million carers exist within the UK, 71% of carers in Northern Ireland provide over 50 hours of care per week, of which is unpaid.

More recent legislation in 2002 addresses many of the points raised in the report published by Carers NI, the Carers and direct payments (www.dh.gov.uk) act ensures that carers are informed of their rights to assessment and gives more power to trusts to supply services direct to carers and also permits trusts to supply direct payments to carers. Flexible working hours can now be requested from employers through the work and families (Northern Ireland) order (2006), this order came into power in April 2007.

More prominently the new Prime Minister Gordon Brown announced on the 3rd of September 07 a standing commission for carers, enabling a much needed profile on carers. The new national carers strategy promises more access to information, financial support and respite care, and the new deal for carers programme due to be published next year. Only time will tell if this can make a real difference to carers and the people they care for. (www.carersni.org). Intermediate care services also need to be enhanced to avoid hospital admissions, promote faster recovery times, support timely discharge, maximise independent living and a good quality single assessment of long term health and social care needs.

All these factors have an effect on whether people receive good community care. Discharge planning is essential to ensuring that patients have all the support vital to receiving the quality of life they deserve. Discharge planning starts when a patient is admitted to the hospital, current circumstances are assessed and the multidisciplinary team, consisting of consultants, occupational therapists, physiotherapists, social workers and nurses liaise between patients their families and each other to plan appropriate health and social packages to enable patients to leave hospital once they are medically fit. However, poor communication