INTRODUCTION
Community hospitals in Scotland have had an important role in the provision of healthcare in predominantly remote and rural communities. In many places they have been providing excellent services to local communities for many years. In the future, they offer ideal opportunities for Community Health Partnerships to develop a wide range of services and to provide a focus for bringing together health and social care services, not just in rural communities but also in urban areas. This strategy sets out a model for new community hospitals fit for a modern NHS where care is delivered closer to the community. Existing community hospitals will have to change if they are to prosper in this new environment. This strategy provides a prescription for that change, while also setting out a vision of the benefits that the new community hospital model could bring in urban and semi-urban settings. The challenge goes out to NHS Boards and their Community Health Partnerships to deliver on this vision as they plan future service provision.
Delivering for Health sets out a range of actions aimed at designing and providing community focused health services which strengthen local communities and enable the NHS to play a full part in promoting good health through community planning, thereby shifting the balance of care and supporting self-care skills. Our aim is a service that is predominantly community based, with services designed and delivered through Community Health Partnerships. Patient safety will always be the paramount concern, but services and care must be provided as close as possible to individuals' homes, with primary care teams working in a co-ordinated and integrated way. We seek to shift the balance of care from an acute setting to a primary and community setting, thereby reducing the need for care in acute hospitals.
Delivering for Health places increasing emphasis on improving health and
well-being by targeting resources at the most socially disadvantaged communities in urban, remote and rural areas, providing effective health promotion and anticipatory care and bolstering people's ability to manage their own conditions in partnership with health and social care professionals.
Our challenge is to refocus community hospitals so that they meet these goals. We envisage a range of Community Health Centres that serve as a base for local diagnostics, treatment, advice and outreach and which could be housed in community hospitals. As such, this strategy supports an expanded role for redesigned community hospitals within wider and local healthcare systems.
The strategy has been developed by:
- mapping current provision of community hospitals in Scotland
- gathering views on future provision from stakeholders
- reviewing existing literature and policy.
Community hospitals need to be brought into the forefront of NHS Board planning for shifting the balance of care to the community through Community Health Partnerships. We need to move away from the old-fashioned narrow view of a community hospital to new community hospitals which will include a range of community resources and services in both urban and rural settings, with or without inpatient beds.
All NHS Boards should take a fresh look at community health services and ask:
- how could the provision of services in community hospitals improve the patient experience?
- how could community hospitals provide additional and new services more locally so that individuals do not have to travel significant distances to access treatment?
- whether existing community hospitals provide the right services in the right setting?
- what gaps in local services could be filled by community hospitals?
- whether additional community hospitals might be developed in order to provide these services?
It is vital that all health services provided are safe and effective and NHS Boards will continue to be accountable for clinical quality, risk management and patient safety.
It is essential that the workforce requirement for new style community hospitals is determined and that staff are trained for new and evolving roles. Those working in community hospitals make a vital contribution to the healthcare system and are highly motivated; however, our proposals require Boards to carefully consider the size, competencies, skills and training needs of the community hospital workforce.
This strategy highlights the need for IT developments in line with our eHealth strategy to take account of the specific needs of the new community hospitals:
- to ensure that community hospitals are included in the development of the Electronic Health Record
- to maximise the use of IT for communication within community hospitals and across the NHS, for example for telemedicine consultations and remote diagnosis
- to enhance the training and education opportunities for staff in community hospitals.
The strategy sends out the following clear messages:
- the new community hospital will play an important role in delivering and developing services needed within extended primary care, as set out in Community Health Partnership schemes of establishment and in Delivering for Health
- the new community hospital model must be an integral part of plans for the whole health service provision within NHS Board areas and include the development of Community Health Centres
- community hospitals have a place in both urban and rural settings, with or without inpatient beds
- the potential of community hospitals will require the development of enhanced roles for staff, with training and educational opportunities for career development
- planning of technological needs of community hospitals must be aligned with the eHealth strategy and must make full use of the available opportunities through IM&T development.
This strategy calls on NHS Boards to set in place the structures that are necessary to ensure that community hospitals can make the shift required by Delivering for Health and provides direction for NHS Boards as they work to provide and sustain community hospitals at the heart of local healthcare.