Managing budgets in mental health services, which have seen huge bed cuts over recent decades ,has shown me that to do aspects of community services properly ' tends to need at least as much resource as hospital care. However it is seen as a cheaper option. Therein lies the problem . It can of course be done much cheaper but invariably the patient experience will be way poorer than they would have received in hospital.
Must include suitable housing please read my blog taken from recent letter to Simon Stevens http://onmybiketoo.blogspot.co.uk
Sadly community care particularly for the elderly hardly counts as care at all. If given in their own home is often rushed and based on a tick box approach and is not always what the person wants. The people providing the care are often driven by financial need for money not love of the job and it shows. There can be economies in scale if shared accommodation is thought through, learning disability have some good models as do Anchor. Being old, disabled and alone is not healthy.
As a retired GP, Psychiatrist who was a shadow Public Health Minister in Scotland for 9years I have been all too aware of the shortfall between rhetoric and reality in shifting the balance of care.The current shifts proposed are quite unlike the closure of long term learning disability beds where double funding made it easier to overcome the concerns of families. Such shift as has taken place to general practice has not been funded either at all or minimally. At the same time the underappreciated thrid sector has been cut and subject to annual funding rounds with substantial demoralisation of staff subject to repearpted provisional redundancy notices or short term contracts. Meantime here our Local Councils have not only had the cuts since 2011 but a freeze on council tax 2007-2016 which has been devastating to social care. Despite this the crisis is less than in England because we have more beds. So despite the fact that bed-occupied days have more than doubled since 2011 they are runnning at 45000 per month compared to 200000 p.m. In England when a comparable figure would be c.20,000. ten years after the Kerr report which should have led to increased community based services and closure of a number of local hospital based services the SNP have finally seen that this has to happen but are now faced with the opposition locally they whipped up in 2007 in order (successfully) to win power.
I was pleased to see this column. I made very similar comments in a local HWB event last month to discuss our proposed place plan. To the views picked up by Beccy from the Telegraph and Jo's contribution above, I added the irony of 'services closer to home' when home itself is becoming increasingly insecure for a large proportion of vulnerable people. I also challenged the mantra that hospitals should only do what only hospitals can do. I suggested that criteria for progressing community services should include Visibility, Accessibility and Flexibility. Finally the weakest point in all my hospital experiences as a patient has consistently been during transition phases. Clinical care is notoriously poor in managing these; weaknesses apparent within a supposedly unified system (hospital) become magnified when the system fragments - especially when private providers without any commitment to flexibility become involved.