Such facilities could house patients after acute assessment or brief admission in the acute facility. Good nursing care and active rehabilitation will be vital which could be led by non-doctors. However, a medical presence will be essential and, as most of the patients will be elderly, we anticipate that care will be under the direction of geriatricians together with general practitioners with a special interest in care of the elderly. Proper medical and nursing staffing will be needed together with appropriate support workers and basic diagnostic and investigative facilities. It is entirely possible that Day Hospital facilities be co-located with the Community Hospital.
Nursing homes are a critical component of community care.
However there are many defects in the way these are run at present and clinical care is often grossly deficient. We anticipate the rapid movement of many outpatient services, particularly for common chronic diseases, into community settings, primarily in association with community hospitals. Community hospitals would have basic investigative facilities available, consistent with serving a population of approximately 100,000. This would have major advantages in terms of accessibility. Some of these services would be nurse led.