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NHS treatment to shift to community-based services

Mixed reception for government's 'new direction' as critics say the reforms are a walk into the past

In today's white paper, 'Our Health, our care, our say: a new direction for community services', the government has unveiled its plan to move hospital treatment back into community-based treatment centres.

The government hopes to build approximately 50 `cottage hospitals' across Britain. Each will feature modern diagnostic and treatment facilities, and will treat patients closer to home. The moves come as part of an effort to reduce the burden on expensive, larger hospitals.

In the long term, the government hope that one in 20 patients will be dealt with in GP surgeries and new 'community hospitals'.

Health Secretary, Patricia Hewitt, has now called for the existing, financially driven momentum behind community-hospital closures to be halted, and reconsidered.

The White Paper will see 'Care campuses' created to bring together social care, diagnostics, minor surgery and basic primary care provided by GPs and nurses.

Included among the main measures are plans to make family doctors open longer hours and set up specialist clinics, while health MoTs will be introduced to monitor patient health at long intervals throughout their life.

The private and voluntary sectors will be invited to pitch for contracts to supply services for the NHS community market. This includes a push to get high street stores like Boots, and Tesco to set up clinics on their premises.

Ms Hewitt's plans have aroused a confused chorus of praise and criticism. Praise, because most experts agree that community-based care is right for national health. Criticism, because Labour dismantled John Major's version of community care, and now, 10 years later appear to be reverting back to it when it now seems unaffordable.

People have been calling for community-based care for years. Indeed, Barbara Castle, Health Secretary for Harold Wilson's Labour government, laid out virtually identical plans in 1976, in her white paper, Priorities for health and social services - an era that many Labour MPs prefer to forget.

Ms Hewitt has been forced to defend her intentions to introduce market forces to local health. She told BBC Radio 4's Today programme: ìIn the areasÖthat have never had enough GPs, or where services simply aren't satisfactoryÖit makes sense for the local NHS to invite anyone who is interested.î

The British Medical Association (BMA) warned that there weren't enough doctors to provide the new services. Dr Hamish Meldrum, chairman of the BMA's GPs committee, commented: ìWe cannot stretch our existing workforce any further.î

The fear for the BMA is that gaps in NHS numbers will be filled with private workers, an easy but potentially hazardous move.

Joyce Robins, co-director of campaigning group Patient Concern echoed doctors' concerns. She told BBC News: ìThe main complaints from patients are that they cannot see a GP. Why? Because there aren't enough of them. This isn't simply deprived areas, this is everywhere.î

Other doctors fear that attempts to make doctor-patient relationships more convenient, even trivial, are dangerous. Laurence Buckman, a member of the BMA's GPs committee, told the BBC: ìContinuity of care, and continuity of recordÖis very important. The guy in the supermarket who sees a patient once isn't going to know their past history.î

The shadow Health Secretary, Andrew Lansley, was amazed at the government's plans. He called it: ìPatricia's Adventures in Wonderland,î and warned that, ìPrimary care trusts are cutting back now on precisely those services on which [Hewitt's] White Paper depends.î There are 350 community hospitals of which between 50 and 100 are under threat of closure.

Mr Lansley told the Today programme that the best way to restore community care around patients ìis to return to GP fund holding.î

30th September 2008

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