NEW COMMUNITY HOSPITALS - INVESTING FOR THE FUTURE
Supporting actions need to be set in place to maximise the potential for successful development of care in community hospitals.
Delivering high-quality, safe and effective services
It is essential that services offered in community hospitals are safe, effective and, where possible, evidence-based. Professional teams involved in providing services in community hospitals should adopt a consistent approach, using
evidence-based standards and guidelines to inform practice. Clinical audit arrangements in community hospitals should be consistent with clinical governance arrangements in place across NHS Board areas.
The lack of research-based evidence in the literature on the safety and effectiveness of services in community hospitals should be addressed through a programme of commissioned evaluative research and monitoring of emerging research evidence.
NHS Quality Improvement Scotland ( NHSQIS) will continue to work closely with NHS Boards and other stakeholders to ensure that relevant evidence-based standards and guidelines are used to guide practice in community hospitals and to determine further work necessary to support the range of NHS services provided for local communities.
NHS Boards should ensure that community hospitals work within the existing Board clinical governance framework using appropriate NHSQIS standards and guidelines.
NHS Boards should work closely with NHSQIS to develop standards and guidelines in line with the development of services in community hospitals.
Technological developments
Delivering for Health identifies information sharing as being at the heart of the programme to promote integration across the NHS. It builds on and enhances the eHealth strategy for NHSScotland, centred on the Electronic Health Record ( EHR).
Planning for new style community hospitals must include steps to use and develop IT technology to support their work. This includes the move towards the EHR and ensuring good electronic communication both within the hospital and across other NHS services.
For community hospitals, there are three key areas for particular development:
1. Data collection
Robust, accurate and up-to-date data and information are crucial in underpinning efforts to develop an ongoing evidence base for healthcare services. Regular clinical audits will only be possible through the development of robust data collection and retrieval processes.
2. Remote consultation and reporting
Capacity for telediagnosis and low-cost imaging is developing. Picture archiving and communication systems ( PACS) will allow a radiological test to be conducted in one place and to be reported in another. Such technologies should be deployed where appropriate in community hospital services. The development of the Scottish Centre for Telehealth in NHS Grampian will further enhance the capacity of technology to enable diagnostic services to be offered locally.
Telehealth links will benefit patients and professionals in enabling them to receive expert advice from specialist and tertiary centres.
3. Education and training
For staff, use of IT will enhance education and training opportunities by allowing access to online and electronically stored evidence-based resources and by the use of teleconferencing facilities for distance learning. These resources will support high-quality care and will provide opportunities for community hospital staff to access learning locally.
NHS Boards should ensure that they incorporate community hospitals in their overall implementation of the eHealth strategy, including development of the Electronic Health Record.
NHS Boards should maximise their use of technological developments to enhance the potential of community hospitals to deliver safe and effective services, and to optimise training and educational opportunities for community hospital staff.
NHS Boards should strengthen their technological infrastructure to support these developments.
Building the new community hospital workforce
Responses from stakeholders consulted during the strategy development process indicated that community hospital staff are motivated, dedicated, resourceful and innovative. They provide a solid foundation from which new community hospital services can be developed. Recruitment and retention problems or lack of access to training opportunities can limit the potential for service development.
Delivering for Health identifies measures to address the challenges of staffing and providing education and training for NHS services in remote and rural areas. These measures are likely to have significant positive impact on staff working in new community hospitals in remote and rural areas in Scotland.
Recruitment and retention
Capacity for staffing new style community hospitals must be built through strategies for recruitment and retention and maintaining a skills base within the primary care and community health care team.
The community hospital team profile will need to develop in response to community and individual need. The team could include a range of 'specialist generalists' from medical, nursing, allied health professional, social care and voluntary care backgrounds, and may also include community members. Specialist inputs could be provided by visiting medical and nursing consultants and GPs/health professionals with special interests and skills.
Community nurses, in partnership with other professional and voluntary groups, have an important role in providing care to individuals and families in domiciliary and community settings. The recent review of nursing in the community recommends that this role is built on and strengthened to meet the aims of Delivering for Health.
Recruitment and retention strategies should highlight new style community hospitals as an exciting and valued career route. Job satisfaction will be enhanced by team working and the development of multi-disciplinary education and training opportunities to equip staff for new types of roles and posts.
NHS Boards should develop a strategy for recruitment and retention of staff for community hospitals within their overall workforce plan. This will include the development of new roles.
Education and training
Education and training are cornerstones of ensuring high-quality, effective and safe care and are crucial to the long-term sustainability of primary care and health care teams providing services in community hospitals. Education and training needs should be developed in parallel with the development of services in community hospitals.
Education and training activities must be delivered in ways that suit the circumstances of local teams including a balance of face-to-face and online teaching. However, nurses have a key role in developing and providing new services in Community Health Partnerships. Facilities should be in place to ensure staff in the workplace can access online education resources and
up-to-date evidence through, for example, the NHS e-library and online distance learning courses provided by Further and Higher Education Institutions.
In general, staff training and development should increasingly be planned for teams rather than for single professions or individuals. Clinical leads for Community Health Partnerships have a key role in ensuring that
multi-disciplinary education and training is promoted. Guidelines on training, education and skills acquisition must reflect population, clinical and technological developments.
It is known that people are more likely to stay in the settings in which they have already worked, therefore undergraduate and postgraduate placements should be established in community hospitals for all professional groups. Existing schemes such as the Rural Fellowship Scheme currently operated by NHS Education for Scotland and other locally based schemes provide a model for how to meet this challenge.
NHS Boards should ensure that the training and education of staff is integral to the development of new services and to multi-disciplinary working in community hospitals.
NHS Boards should work with educational institutions to establish clinical placements in community hospitals for all professionals undertaking education.
Infrastructure
Planning for the new community hospital infrastructure should be an integral part of NHS Boards' forward strategies. The design of individual community hospitals will be informed by the needs of local communities and the range of services to be delivered through Community Health Partnerships. Plans must also ensure community hospitals are effective, adaptable and flexible. It is also important that any new assets recognise and support the Scottish Executive's sustainable development strategy.
It is acknowledged that given the historical and cultural developments of community hospitals over many years, NHS Boards will face complicated and sensitive issues when making decisions about reprovision or development of services which may include the closure or selling of premises. This community sense of ownership is also an asset and steps should be taken to harness it, even if the physical building with which it is associated ceases to exist.
NHS Boards should develop a strategy for recruitment and retention of staff for community hospitals within their overall workforce plan. This will include the development of new roles.
Developments are under way to establish the new HUB initiative, which is intended to provide NHS Boards, local authority colleagues and other public sector partners with a new, robust, joint-venture delivery vehicle, drawing in private sector funding and expertise for community building projects. Local HUB company activity has the potential to incorporate health, joint-working and local authority projects which previously would have been pursued independently or within local regeneration or development plans. This will assist NHS Boards in planning new community hospital provision. The HUB has the potential for more cost effective delivery over the lifetime of individual projects and works within a framework where local partners including Community Health Partnerships and Community Planning Partnerships have clear roles.
In order to support service developments and improve the quality of the patient and staff environment capital investment is increasing on average by £60 million each year from 2005-06 to 2007-08. By 2007-08 capital funding will be almost £532 million. The significant increase in capital asset investment will ensure that NHSScotland is better equipped and resourced than ever before, offering opportunities to develop and expand existing provision, to improve facilities and equipment and to deliver the best care.
NHS Boards should ensure that estate planning around community hospitals is integral to the whole service and is driven primarily by strategic service development rather than current estate availability.
NHS Boards should maximise the use of joint planning with local authorities in developing existing and additional community hospital premises according to service needs.
Transport
It is essential that transport is in place to ensure people have optimal access to community hospitals. There is a need for an integrated approach to transport planning for community hospital access including public and private transport, Scottish Ambulance Service and voluntary patient transport. Community Health Partnerships are ideally placed to ensure an integrated approach to transport planning. It is vital that patients, carers and their families can access services as easily as possible. This requires liaison between NHSScotland bodies and local authorities, regional transport partnerships and other stakeholders in the planning and implementation of local and regional transport strategies. Through integrated transport policies and site-specific travel plans, NHSScotland facilities can be made accessible to all.
NHS Boards should have an integrated patient transport policy to include community hospitals.