How language is holding back initiatives to move healthcare into the community
The importance of community healthcare
It is widely acknowledged that healthcare in the community has an important role to play in alleviating pressure on hospitals and – crucially – improving patient outcomes. This view has not simply arisen as a response to the pressures placed on hospitals by the ongoing COVID-19 pandemic: in fact, it has been prevalent for some time.
Hospital vs community healthcare and the benefits of a population health approach
NHS England’s Five Year Forward View, which dates back to 2014, and their 2019 Long Term Plan both outline a commitment to prioritising community-based services and expanding community health provision.
Community healthcare facilities and professionals are already providing an invaluable service, without which the NHS would have been unable to meet the ongoing demands presented by the pandemic and its aftermath. In the face of such extraordinary challenges, community healthcare is not subject to the same capacity restrictions as hospital-based services.
Clara Gilfillian, lead for nursing at East Suffolk and North Essex NHS Foundation Trust rightly points out, “we cannot close our doors and have no restriction on beds”.
Despite the proven benefits of a community-based model, initiatives to move patients out of bricks and mortar and into the community are still stigmatised by the public perception that community-based care is less important and of lower quality than healthcare provided in hospital. The long-standing belief that only hospitals can provide the ‘gold standard’ of healthcare is perpetuated by the language we use on a daily basis.
The power of language in healthcare
If we are to learn from historic models of care and put community services at the front and centre of the ongoing digital transformation in healthcare, then the first step must be to address the language used to describe community-based care.
During an HSJ webinar earlier this year, Raj Jain, Chief Executive of the Salford Royal NHS Foundation Trust said: “Virtual clinics/wards, admissions avoidance, early discharge… they’re all hospital-based terms for community healthcare. We need to change the narrative to become more community focused. Instead of ‘admissions avoidance’, community service should be the pinnacle.”
Crystal Oldman, Chief Executive of the Queen’s Nursing Institute added: “We talk about hospital at home services, but that gives the subtle message that that’s where all the ‘important’ stuff happens, lives are saved etc. when actually 90% of all clinical care happens in the community”.
By continuing to discuss community healthcare in this way – as the secondary, inferior option to hospital care – then we diminish its value, contributing to existing biases and perpetuating the long-held preference for hospital care among healthcare consumers.
Improving perceptions of community healthcare
Creating a more positive language around community healthcare will give it greater importance, its image among service users.
Changing public perceptions through inclusive language is not a novel concept. We already have a broad understanding of how language can be discriminatory, particularly when referring to a person’s diagnosis, ethnicity, disability, sexuality or any other marker which could be used to marginalise or exclude specific groups or individuals.
Reflecting on the language we use surrounding healthcare provision – specifically when discussing community-based versus acute models of care – can help to shift the focus away from hospital settings and towards the community. Perhaps then can we slowly – but meaningfully – begin to alter the perception of community healthcare as the poor relation to acute services.
Community: the future of healthcare
If the COVID-19 pandemic has taught us anything, it’s that capacity and demand can be managed more effectively in the community – offering enhanced safety and visibility, and better outcomes for patients – than in a hospital setting.
Shifting healthcare into the community is the first – and perhaps most important – step in improving the health and wellbeing of the population. In order to achieve this, we need to adjust our language, place community at centre stage, and provide community initiatives with the funding and technological support they need to enable them to thrive.