Community and acute care

Editor – I had the pleasure of reading Nigel Edwards’ article regarding the Future Hospital Commission in the June issue of the Future Hospital Journal (FHJ June 2014 pp. 13–15).

I am a retired consultant geriatrician, with 33 years of experience as consultant across both community and acute services. Before my retirement, my geriatrician colleagues and I had acute on-call work as well as community hospital responsibilities looking after rehabilitation patients. This arrangement worked well until the community hospital was taken over by the CHC. They were unable to fill the consultant posts in the community, and so combined posts in acute and community hospitals were created in the relevant specialities. The community physicians continued to provide a similar service to that which we previously provided. Since retirement, I have worked in a community hospital in Surrey as a part time consultant in elderly care.

My experience on both ‘sides of the fence’ has informed my belief that an artificial barrier between community and acute hospitals is not good for the service or for the patients, and I would agree with Nigel Edwards’ comment that the same consultants should look after the patient in both acute and rehab wards, treating their care as one episode. If we have responsibilities on both sides, we tend to select the appropriate patients for either further care and investigation in the acute hospital or rehabilitation in the community services, and avoid using the community hospital as a ‘dumping ground’. This also reduces transfers and the associated discontinuity of care and disorientation for the patient. We unfortunately have enough fragmentation of services within the acute wards.

I would also urge policymakers to see what is available in the community now. We need to strengthen community hospitals, GP practices and community nursing care before sending the patient out of the acute hospital to community care, as we all know what happened to mental health services. If we fail to do this, transferring patients to community care might free up more acute beds, but these will be filled up by failed discharges.

As an experienced physician, I would caution against jumping on the ‘community care’ band wagon. It may sound nice, and may have support from patients and relatives who would prefer not to travel a long way to a busy hospital, but we need to prioritise the quality of care and facilities available.