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In the UK at present there is a constant pressure for inpatient beds; with this comes a need to develop services so that patients can be managed in their own homes. Although community nursing has historically been synonymous with district nursing, with the ageing population and the need to manage the increasing numbers of patients who have long-term conditions, community nursing is changing. This article describes a hospital in the home service, developed by one NHS trust; it not only delivers care traditionally provided in hospitals, but is also an effective setting for student nurses to undertake practice placements.

In times of financial restrictions and reform impediments, health services need to invest in resources that provide value for money and reduce hospital admissions. Improving disease management in the community is a primary target for those trying to reduce costs. The second most common cause of emergency admissions to hospital is chronic obstructive pulmonary disease and it has been suggested that more effective treatments and better management of the condition would likely result in an estimated 5% fewer admissions to hospital, saving around pound 15.5m each year. This article discusses how savings could be made by improving care provided in the community.

This article describes a pilot telehealth project in Swansea where patients with heart failure and chronic obstructive pulmonary disease were provided with telehealth monitoring equipment. While early evaluation points to some potential economic benefits, supporting patient empowerment was a significant outcome.

Modern day palliative care has developed over the past 40 years and many government policies have been produced to support the development of services. Guidance sets out the aims and objectives for delivering palliative care, which are that every person with a life threatening illness has the right to receive appropriate palliative care wherever they are. This article explores whether people do have a choice about the care they receive and where that care is delivered.

This article examines the problems of caring for people with interstitial lung disease in primary care. It describes simple strategies that can support people to remain at home during the end stage of their illness. The diagnosis and investigations of ILD have been covered in previous Nursing Times articles (Duck, 2007a; 2007b).

This article follows the development of an intermediate care service for older people with mental health needs and assesses the impact of the service on patients, carers and referrers, and the availability of dedicated elderly mentally ill (EMI) beds.

This article outlines an initiative to reduce length of stay for stroke patients within an acute hospital and to facilitate earlier transfer of care. Existing care provision was remodelled and expanded to deliver stroke care to patients within a community bed-based intermediate care facility or intermediate care at home. This new model of care has improved the delivery of rehabilitation through alternative and innovative ways of addressing service delivery that meet the needs of the patients.

This article outlines an initiative to provide rapid access to specialist services for older people with mental health difficulties living in care homes. It outlines the main aims of the service and its impact. The service has significantly reduced unnecessary hospital admissions.

Carol Kelly and Dave Lynes discuss the evidence and assessment for domiciliary oxygen, as well as considering oxygen therapy in palliative care.

Palliative care services provided by the primary sector have changed considerably over recent years and patients and carers want choice over end-of-life care. In response to this need, the Macmillan Gold Standards Framework has been introduced and funded by the NHS as its chosen end-of-life programme. Clinical experience suggests the framework provides a better quality of care, improves staff morale and patient satisfaction, and reduces hospital and hospice occupancy.

The changing training needs of the mental health workforce have been increasingly highlighted in recent years with the national development of new services like crisis resolution/home treatment teams. This article presents some key changes made to short training courses in crisis resolution.

Changes to the new home oxygen service have raised awareness among health professionals of the potential hazards and benefits of oxygen therapy. Annette Duck reviews the use of long-term oxygen therapy and highlights the importance of assessment in selecting both patients and suitable delivery systems.

Asthma is the most common chronic disease of childhood and ranks as the main reason for acute paediatric hospital admissions (Arshad, 2002). The overall prevalence of asthma in England and Wales is about eight to 10 per cent (National Institute for Clinical Excellence, 2000), with one in seven children aged between two and 15 in the UK having symptoms which require treatment (Rees and Kanabar, 2000).

The British Thoracic Society (1997) defines chronic obstructive pulmonary disease (COPD) as a chronic, slowly progressive disorder that causes significant mortality and morbidity. In most cases it is caused by smoking tobacco.

Current government health policy calls for increased collaboration between acute and primary care, and between the NHS and the independent sector. This article describes an initiative in which an NHS trust contracted an independent company to provide home chemotherapy for patients with cancer of the colon. Home-based therapy enables patients to choose the service that suits them most, and can reduce the stress associated with their disease and treatment. It has also been found to reduce the side-effects of treatment. This article includes a case study on a patient receiving home chemotherapy which illustrates some of the benefits of the service for patients.

A King's Fund report on mental health in London (1997) highlighted the difficulty of adequately meeting the needs of older people with mental health problems. This article describes the work of the home nursing team, a London project that aims to provide appropriate care for this group of clients during the acute phase of their illness. The six-member mixed-grade nursing team provides care in the client's own home, providing an alternative to hospital admission. The team aims to be sensitive to the needs and wishes of clients and involve them in decisions about their care. Team members work closely with carers and other services, ensuring continuity of care.

This article describes how a children's home care service operates as part of a general paediatric service within an acute NHS trust. Although a debate exists about whether a home care service should be set up as part of a community or acute trust, there are advantages and drawbacks for staff within either system. The authors believe that children benefit regardless of where the service is based.