Letters

I read 'Closer to home' (open space, page 27, 10 August) with great interest.

The Community and District Nursing Association believes that 24hour community services could fulfil many of the tasks envisioned for intermediate care without the intensity of revolution anticipated in the article.

The Community and District Nursing Association has, for some years now, been campaigning for the NHS to become a true national health service and not simply a national hospital service, the hospital traditionally being the main focus of health spending. The direction of recent government policy has, we feel, begun to redress the balance.

The CDNA has been engaged in the consultation processes for several major government exercises, including the NHS plan and the national beds enquiry.

All these issues have major logistical, financial and policy implications.We believe that 24-hour community nursing services, while not the panacea, is the common thread that offers a range of solutions that will make the NHS flexible, patient-centred and cost-effective.

As cited in your article, the recent Department of Health report estimates that at least one in five beds is currently filled by patients who neither want, nor have to be in, them.

This obviously shows scope for further reductions in hospital beds occupancy - but only if community services offer full 24-hour cover.

Many patients are in hospital beds because they need 24-hour access to care, not because they require an acute bed. The standard response given for not initiating UK-wide 24hour community services is cost.

It would seem self-evident that community care is more cost-effective than acute care, and if 24hour cover were introduced it would quickly begin to shoulder the burden falling on expensive hospital beds.

With the average patient cost per bed being£1,200 per week, even a moderate shift away from the trend towards more hospital admission would allow the NHS to reallocate significant sums.

A 24-hour community service would consequently be able to treat far more elderly people in their own homes. Potentially emotive funding propositions - for example, patients releasing equity from their homes - would become irrelevant as their homes would become their 'ward'.

To provide the level of service and cover required in an integrated longterm care system, there would need to be a large pool of highly skilled community and district nurses.

This could represent the biggest 'missed opportunity' for the NHS to regain its status as the most innovative, cost-effective and comprehensive healthcare system in the world.

Heather Ballard National professional officer Community and District Nursing Association