LETTERS

While sharing Dr Tim Evans' concerns about the number of independent sector homes that are closing (Independents' day, page 20, 3 May), I believe we need to balance the process of negotiating realistic rates for intermediate and continuing care with the development of a whole continuum of services for vulnerable people.

In delivering the targets in the NHS plan, we are clearly going to have to look to the independent sector to play its part, not only in providing some of the intermediate care places, but also in freeing some of the capacity needed to meet the waiting-times standards.

Statutory sectors do not necessarily have the infrastructure to deliver this bed capacity, and in the spirit of the concordat it would make sense to look at existing bed availability.

The challenge for primary care organisations is to work with a whole range of partners to allow older people to maintain their independence in their own homes as far as possible. Our aim, together, has to be to postpone admission to any sort of institutionalised bed for as long as possible. At last there is a recognition, within the national service framework for older people, of the importance of health promotion for this group; we need schemes to keep older people active, nourished and warm.

As both commissioners and providers, primary care organisations are well placed to develop ways of responding to crises at home, increasingly in integrated teams involving social care. Making use of local authority residential accommodation as a base for rehabilitation is another aspect of partnership working that needs to be explored further. We also need to think about partnerships around the workforce, for recruitment and retention, education and training.

Of course, such initiatives will not make up for the growing shortfall in independent homes, or halt the number of closures.

But working together will help us all. We need to respond to the real economic concerns of the sector. As commissioners, we need to be clear about what services we want to see provided, how we will fund such services and then agree more responsive approaches to the independent sector, looking at priorities for funding and robust contracts.

Owen Richards Executive director South Essex HA