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Last Updated: Monday, 30 January 2006, 15:58 GMT
Move to push NHS into community
Stethoscope
The white paper covers NHS care out of hospitals, such as GPs and mental health
The government has unveiled proposals to make NHS care in England more accessible by shifting services from hospitals into the community.

The white paper could see specialisms such as ear, nose and throat and dermatology carried out in new community hospitals and GP surgeries.

The GP market could also be opened to the private and voluntary sector to help fill gaps in under-doctored areas.

Opposition parties said the measures would make little difference.

And others claim they will struggle without extra investment.

But Health Secretary Patricia Hewitt said the white paper represented a "major strategic shift".

We are very much wanting to make ourselves more accessible, but we need to expand the numbers
Dr Hamish Meldrum, of the British Medical Association

"It will pave the way for many changes to the services people receive in the community.

"The plans will help people to access community services throughout all stages of their lives and in places and at time that suit them."

But she denied the shift, which will see fewer patients treated in hospital, would worsen the financial crisis in the NHS.

Debts

One in four trusts finished last year in deficit, with hospitals being forced to close wards, freeze recruitment and delay operations to balance the books.

And she also tried to allay fears about the involvement of private firms, pointing out GPs have operated as small businesses since the NHS was first set up.

To date, the private sector role in the NHS has been largely confined to hospital operations.

But ministers want to see health firms and voluntary organisations running GP practices, as well as nurses, pharmacists and other health professionals, such as physios, being given more responsibility.

A health MoT for everyone might sound attractive, but is highly unlikely to be cost effective
Steve Webb, Liberal Democrat health spokesman

Department of Health officials said the white paper had been designed to help deprived areas, where shortages in provision tended to be most acute.

The white paper is also aimed at helping people manage their long-term conditions better to reduce unnecessary hospital admissions.

The majority of the measures are expected to be funded through money already promised to the health service so that in the next 10 years the proportion of the NHS budget spent on community NHS services rises by 5% to a third - to bring it up to OECD standards.

Among the measures outlined are:

  • Push for a new generation of community hospitals, providing diagnostics, minor surgery, intermediate care and basic primary care. Labour promised another 50 such centres - new or refurbished - in their manifesto and Ms Hewitt has called on local health bosses to review the current hospitals under threat

  • Family doctors to be encouraged to open for longer and set up specialist clinics for conditions such as diabetes and ear, nose and throat treatment. These could be run by either GPs or hospital

  • Social workers to be more incorporated into the NHS by being placed alongside GPs in surgeries and care campuses and through closer co-operation between councils and NHS trusts

  • Health MoTs introduced giving patients the option of having a health check up to see if they are at risk of developing conditions such as heart disease and diabetes

  • The private and voluntary sector are being encouraged to get involved in NHS community market, while there is a push for high street stores such as Boots and Tesco to host health clinics

    Dr Hamish Meldrum, chairman of the British Medical Association, said the shift in emphasis was welcome, but added without extra capacity better access would be hard.

    But he added: "The main problem is lack of GPs. We are very much wanting to make ourselves more accessible, but we need to expand the numbers."

    HAVE YOUR SAY
    There is absolutely no evidence it will do anything for health. The policy is pure, cynical, populism
    Rowan Harwood, Nottingham

    The BMA has also called for NHS providers to be given a chance to fill the gaps in care before private firms are allowed in.

    Shadow Health Secretary Andrew Lansley said the government was "moving in the wrong direction".

    "The government's white paper leaves many questions unanswered. Many primary care trusts are cutting back precisely the community-based services on which the care plan depends."

    And Liberal Democrat health spokesman Steve Webb said: "A health MoT for everyone might sound attractive, but is highly unlikely to be cost effective.

    "There is a real danger of surgeries being swamped by the 'worried well' while people in real need have longer to wait"

    He also said the financial crisis in the NHS - one in four trusts finished last year in deficit - was threatening community services.




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