'NHS must cut beds for better care' - Chief Nurse

THE NHS should spend more money looking after patients in their own homes instead of paying for hospital beds, the country's chief nursing officer warns today.

Jane Cummings, chief nursing officer at NHS England, said patients were being denied care at home because too much cash was devoted to paying for "old and expensive buildings".

Writing in The Daily Telegraph, she said the absence of adequate home care was trapping people in extended hospital stays which made them more ill.

She also called on health bosses to use a round of regional reorganisations to shake up "outdated" care methods and prevent patients "falling into the cracks" between different parts of the system.

She acknowledged, however, that refocusing the health service would be "controversial". The NHS is battling record levels of bed-blocking in hospitals due to the crisis in elderly care, which regulators have said has reached a "tipping point" because of the closure of residential homes and shortage of domestic carers.

Delays in the transfer of care are estimated to cost the health service around £900 million a year, with the cost of keeping an elderly person in hospital for a week about £3,000.

"With more care provided at home, the NHS can spend more cash on patients rather than maintaining old and expensive buildings," she said.

"More people can be better looked after with care personalised to their needs," she added.

On a local level, she said, the NHS "wants to invest in home-based care, but it struggles because resources are currently tied up in hospital beds".

Hospitals and other providers in England overspent by at least £2.45 billion in the last financial year, prompting the NHS to divide the country into 44 areas, ordering local managers and councils to come up with restructuring plans to improve efficiency.

A number of the schemes, called "Sustainability and Transformation Plans", have been criticised as heralding closures of A&E units and cuts to hospital beds.

But Prof Cummings said the restructurings provide a chance to make services smarter.

"As life expectancy increases, so do the ailments of old age and there are now more people with chronic conditions like heart failure and arthritis," she said.

"There are also big opportunities to improve care by making commonsense changes to how the NHS historically works, improvements that matter like making it easier to see a GP, speeding up cancer diagnosis and offering help faster to people with mental ill health."

Other commentators, however, have noted that the crisis in social careand the resulting bed blocking will only be solved if a significant chunk of the NHS budget, which is around £126 billion, is transferred to the £17 billion social care pot, which is administered by local authorities.

The chief nursing officer said that, as well as enabling more patients to be treated at home, restructuring should embrace smaller numbers of specialist centres, where appropriately trained staff are "available round the clock".

She cited stroke services in London, where the number of stroke wards was controversially reduced in favour of a small handful of "hyper-acute" units, which the NHS claims has saved the lives of 100 patients a year.

Proposals for each part of the country have now been made and are being scrutinised by NHS executives. They involve a £30 million scheme in Surrey to take pressure off hospitals by giving people more access to GPs. In south-east London, plans involve a scheme for 16,000 extra radiotherapy appointments and 4,600 more chemotherapy treatments a year from early 2017.

"While there will always be debate about how much money the nation invests in the NHS and social care, that does not change our responsibility to patients, which is to squeeze the maximum value from every penny available," said Prof Cummings.

The head of the King's Fund think tank, Prof Chris Ham, said treatment at home was the "right thing to do" but needed greater overall spending.

"It's been part of the conventional wisdom in the NHS for some time now," he said. "But it will need investment outside hospital services - GPs, social care, district nurses - before you can realistically cut back on hospital beds.

"At the moment we know hospitals are running very hot at capacity and over capacity and the only way we can help that is to stop people turning up.

"That requires money on staff. [Now] it's all going on deficit reduction."

SOURCE: Telegraph, Henry Bodkin