Dr Chaand Nagpaul: Remedying social care failings critical to future health of NHS

Yet, for many, it is an 
essential lifeline and can often 
be some of the most important care that a person receives in their lifetime.

It is the community nurse who comes to wash your elderly relative, or the meals on wheels service for those who cannot physically shop and cook for themselves.

Crucially, it is the care that allows a person to live as independently as possible in the comfort of their home and community, maintaining that important sense of dignity.

Community care spans all ages, both for those with physical and mental health needs, and is particularly important for the older population.

We have known for a long time that community and social care is in trouble and this has been further evidenced by a new report this month from NHS Providers.

The report reveals that the failure to adequately fund and prioritise this type of care has meant that promises to bring patient care closer to home have fallen flat.

Nowhere has the impact of failing community care been as clear to see as in the rural communities of England.

Indeed, earlier in the year, North Yorkshire County Council sent a cross-party letter to the Secretary of State for Health and Social Care, and the Shadow Health Minister, warning of a pending workforce crisis in health and social care in the county.

North Yorkshire has one of the country’s largest populations of older people and is an example of an area where it is vital that there is adequate care and support in the community as access to larger towns or cities can be more difficult.

In remoter parts of Yorkshire, the elderly are being faced with the challenges of isolation and are often cut off from family without the added benefits of digital connectivity.

This, coupled with rising care home costs, means that it is absolutely essential that there is adequate care in these hard-to-reach areas.

This involves making it more attractive for staff and being able to effectively mobilise the workforce so they can get to more rural areas.

As with general practice, community teams struggle with the increased workload of trying to manage more complex patients in the community.

In recent times, we are seeing a significant increase in the number of patients with multi-morbidity. Often these patients have a high treatment burden in relation to understanding and self-managing their conditions, such as attending multiple outpatient appointments and managing complex drug regimes.

Many of these patients will 
rely on community care to live the best life possible.

Delayed discharges in hospitals due to a lack of community care can have a dangerous knock-on effect on 
the rest of the NHS.

For instance, during the 
busy winter period when hospitals are already running at capacity and beyond, delays to discharges means there are not enough beds for those in need of urgent care.

Consequently, longer stays also lead to worse health outcomes for older people and can actually increase their care needs after leaving hospital.

Similarly, if a person with dementia doesn’t receive the appropriate support at home, they could become dehydrated which could lead to further complications.

Often dementia patients who do not get the care they need at home then end up in A&E as a last resort, which can be a very disruptive and distressing experience.

Despite Ministers pledging their support for patients being cared for in their own homes, the current reality is instead an impoverished infrastructure of community services.

The BMA has recently launched its Caring, supportive, collaborative: A future vision for the NHS project, intending to promote an honest and robust conversation about the future of the NHS.

One of the main aims of the project is to think about ways in which we can have a more integrated NHS and joined-up approach.

Part of this involves the greater integration of community care with other aspects of healthcare.

We can see the benefits when this works well as it provides a more holistic approach to patient care which is of invaluable benefit to a patient.

We need a realistic solution and one which brings community care back into the spotlight.

When we invest in community care, we are investing in the community and in people.

This will always pay off in the long run.

Dr Chaand Nagpaul is Chair of the British Medical Association.