Published: 22/09/2005, Volume II5, No. 5967 Page 26
Liz Meerabeau, Greenwich University
As a health visitor, I have been disappointed and concerned at the relative lack of coverage of the effects of the primary care reforms (news, page 5, 8 September) on district nursing and health visiting services.
While for some staff there may be entrepreneurial opportunities, others may not wish to go down that route. Apart from the employment uncertainty (not exactly Improving Working Lives), the effects on clients do not seem to have been addressed.
West Yorkshire strategic health authority chief executive Mike Farrar (Interview, pages 20-21, 8 September) speaks about 'breaking up a state monopoly and generating quality by contestability', but it is not clear firstly that community services can be meaningfully described as a 'state monopoly', nor that quality will be improved by using a market model. There is ample evidence that markets only work well when the customer has some economic clout, and this is unlikely to be the case for many of the most vulnerable recipients of community services.
A few observations:
Have the lessons from the regulation (not deregulation, as Mike Farrar states) of the residential care sector, and the consequent market exits and loss of provision, been factored in to policy-making for primary care?
Have the lessons from the social care sector, which is about 80 per cent independently provided, and has many small providers who find it difficult to fund continuing professional development for their staff, been factored in?
What will be the incentives for providers to provide services in our most challenging and disadvantaged communities, and how will staff be recruited to work there, particularly if they no longer have access to the NHS pension and other benefits?
Might these services require a premium, driving up NHS costs?
Kate Wortham, allied health professionals and other practitioners lead, and Yvonne Sawbridge, nurse lead, NHS Alliance
HSJ's Comment (page 3, 1 September) and following articles in the same issue expressed protests and uncertainties over changes to primary care trust-provided services.
The focus on the implementation of Commissioning a Patient-led NHS is correctly turning to include PCTprovided services. These include community nursing services, such as district nursing, health visiting, school nursing and specialist nursing, and many allied health professionals services, such as physiotherapy, occupational therapy, speech and language therapy, nutrition and dietetics and podiatry.
For these services and the frontline clinicians providing them, community and primary care is the right place for them in terms of their place within the NHS family.
There is now doubt as to whether these services will remain part of the NHS family; which organisation will manage the services and employ the staff; and what the future holds for the health professionals.
The transfer, or 'divestment', of these services by PCTs leaves individual frontline professional staff vulnerable. Many careers are likely to be put on hold and the motivation to stay with these services must surely suffer.
It is crucial that these services find the management organisation(s) that will ensure the right focus, availability and integration of the services within health and social care. For many, the return to an acute care-focused organisation would not achieve these ends.
Meanwhile, it is vital these services remain attractive to people from these professions both now and in the future. This must include providing appropriate rewards and access to career progression. Interim uncertainties must be managed with care.
Success will be seen as the right services in the right place for a patient-led NHS, with good recruitment to, and retention of, health professionals within these frontline services.
No comments yet