Thursday, February 02, 2006


"Thrashing about" might describe it better. They clearly do not know where to turn.

The community hospital, a part of the health service threatened with widespread closures, is to be recast as a centrepiece of the NHS after a government rethink. Sweeping changes to the NHS, outlined yesterday in the long-awaited community services White Paper, will mean community hospitals taking on a significant role in efforts to provide more care to patients closer to home. The initiative comes after big cuts to community hospital care, with more than 90 thought to be at threat of imminent closure. Many of these will now be redeveloped as part of the restructuring of primary care, and the Government plans to build a “new generation” of 50 community hospitals over the next ten years. The hospitals, modelled on “polyclinics” pioneered in Germany, will be state-of-the-art but without the A&E departments that generate emergency pressures on district general hospitals.

The move is designed to provide more care and treatment outside the costly setting of traditional acute hospitals. The White Paper also pledges to improve access to GP practices, encouraging them to stay open for longer to meet local demand. In areas that are under-served by GPs and primary care services, private providers could be brought in. The reforms are also designed to provide more support for carers and encourage people to have regular health “MoTs”. While the 200-page White Paper was broadly welcomed last night, it raised concerns as to how acute hospitals would cope with fewer patients — and the resulting reduced income.

Chris Ham, former head of strategy at the Department of Health, said that it would likely prompt the closure or severe scaling-back of larger hospitals. He added that those hospitals tied into long-term repayment contracts with the private sector could face serious problems.

The White Paper said that in its aim to deliver more specialist care locally, “a new generation of community facilities” would need to be created. It stated that over the next five years the Government will develop “a new generation of modern NHS community hospitals”, as set out in its manifesto pledge. There are about 350 community hospitals in England, mostly owned and run by primary care trusts.

Patricia Hewitt, the Health Secretary, said that over the next ten years she wanted to see 5 per cent of resources — about £2.5 billion from the NHS budget — shifted from secondary to primary care. “Nearly 90 per cent of patient contact occurs in the community and is trusted, but we still spend below the European average on primary care,” she said. She said that where community hospitals were not considered viable to serve the local population, it was right that they should close, adding: “But if there are community facilities that are needed for the long-term they shouldn’t be closed down due to short-term budgetary problems.”

Ms Hewitt denied that taking more treatment out of hospitals would destabilise finances. She said that hospitals would be more able to treat the most complex patients while more routine procedures were carried out locally. The Health Secretary added that the Government was working with the medical royal colleges to consider which specialities — such as dermatology, orthopaedics and gynaecology — could be bought out of hospitals and nearer to people.

Details of health MOTs — providing people with check-ups at key points in their life — were also outlined. The initiative will take the form of a questionnaire that patients complete online or on paper. If problems are shown up they may be invited for a face-to-face consultation with a GP. The White Paper said that it would soon be easier for patients to register with the practice they wanted but the idea of letting patients register with two GPs — one near home and one near where their work — has been ruled out after being branded difficult and costly. Reforms of social care will include a respite service, to give people a break from caring for relatives or friends, and other support such as a helpline.

Health campaigners and doctors last night insisted that more money was needed if the Government was to succeed in meeting its ambitious pledges. Many questioned how the NHS would be able to pay for the plans set out in the White Paper as it is already hundreds of millions of pounds in the red.

Ms Hewitt said that some funding for the reforms would come from the Department of Health’s central budget, while other aspects would be covered by the large increases in funding for the NHS set for the next few years.

Andrew Lansley, the Conservative health spokesman, said that the White Paper left many questions unanswered. “Many primary care trusts are cutting back precisely the community-based services on which her care plan depends,” he said. “The White Paper fails to face up to the reality of the NHS today. It fails to provide the necessary long-term reforms which will deliver the improvements in the NHS which everyone — staff and patients, so badly want.”



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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