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Our focus must be on community settings

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Community settings need attention too Community settings need attention too

The new NHS architecture comes into being on the day this issue of Independent Nurse is published. Statistics about the incoming structures have abounded in the media and the debate about the impact on patients and services has been growing to a crescendo.

Much discussion has focused on acute care commissioning and the way in which clinical commissioning groups in England will be responsible for commissioning the majority of acute care for their populations. Media attention has been heavily focused on the impact on hospital services. This has made the facts I have just heard about of even greater significance.

Last week, I attended a conference in Edinburgh hosted by the International Collaboration on Community Health Nursing Research and our sister organisation, the Queen's Nursing Institute Scotland. It was a fabulous event with representation from nurses from 19 countries. The excellent standard of inspiring presentations makes it hard to select one for comment, but statistics provided by researchers examining end-of-life care for patients with dementia in care homes were striking.

Professor Clare Goodman at the University of Hertfordshire advised the audience that in the UK in 2012 there were 159,386 (and falling) NHS hospital beds and 459,448 (and rising) beds in care homes. Of these, 40% were in nursing homes and 60% in residential care homes. The median length of stay for patients in the nursing homes was one to two years and in the residential care homes, two to three years.

These figures brought home the significance of the nursing care we provide outside of hospitals. With a growing frail, elderly population with complex long-term conditions, the numbers of beds in care homes and nursing homes are likely only to rise. More nurses will be employed within the homes or will visit residents as part of their community role. Such care will be critical to supporting patients to stay in familiar home surroundings and to avoid hospital admissions.

Crystal Oldman, chief executive, Queen's Nursing Institute

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