A ‘long-term plan’

At last, the NHS Long Term Plan (NHS England, 2019) promises significant investment in out-of-hospital care. This promise includes an expansion of community nursing services so that they can respond in a timely manner and provide adequate support to people in their own homes, thereby preventing avoidable hospital admissions. But the expansion will need to compensate for the additional nursing work likely to arise from the increasing number of urgent care centres providing same-day emergency care as well as shortened hospital stays through early discharges, in addition to the anticipated increase in proactive general practice care. This step change will require planning and careful implementation so that long waits in the home do not simply replace long waits for nursing care in hospital corridors or wards.

It has always struck me as ridiculous that acute hospital care has been able to command the largest claim on the NHS budget so that preventive action to avoid ill health has been largely neglected through underfunding and lack of media attention. The promise to address health inequalities and invest in prevention is therefore to be welcomed. But only time will tell whether the plan will address the medical and nursing hierarchies where hospital consultants and hospital nurses are accorded more prestige than general practitioners and community nurses, whose daily practice involves helping people to live as healthily as possible, self-manage their health issues and maximise their quality of life.