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Our health, our care, our say: it's long but not that strong

Lynn Young
Lynn Young
Primary Healthcare Adviser
RCN

The White Paper describing a new direction for community services is currently being discussed, provoking a flow of ideas on how to make grand aspirations a reality for patients and the workforce within a horribly financially restricted NHS.
The most significant criticism of Our health, our care, our say is that it is too long and the authors should have restricted the content by 50%. However, this is no time to be churlish as there is much to welcome within the 220 pages, and nurses are well advised to take heed of government intentions for the future of primary care. As suspected, the drive to further integrate health and social care is emphasised, as is the focus on the need to prevent disease and help people manage their long-term conditions better. This is abundantly good sense and an aspect of healthcare that should have been addressed by the NHS and other agencies before now.
Writing in the foreword, Patricia Hewitt, secretary of state for health, asks: "How do we help every individual and every community get the most out of life in a country that has never been richer in opportunity than today?"
Here is the good news: at last it is on record that the health challenges - which include addressing health inequalities - will not be met by simply improving hospitals. It is time for primary care to seriously consider how the 90% of healthcare contacts taking place outside hospitals can be made more effective and efficient.
So yet more reform is soon to be thrust upon primary care and new, non-NHS organisations are invited to bid to provide care in areas that are currently under-served. In addressing inequalities, efforts will be made to bring in the independent sector and not-for-profit social enterprise organisations to locations where poor people - and therefore the least healthy - receive the least care. General practice is being asked to extend its opening hours to improve access and enable more patient choice, and PCTs and those involved in practice-based commissioning are encouraged to make genuine secondary sector savings so that new funds can enhance primary care capacity. Public consultations showed that people want more and better community services; better information to help take responsibility for their health; and no community hospital closures.
Government also wishes to see competitive tendering taking place in the community, which the RCN has criticised as an unnecessary experiment in trying to improve the health and care of the most deprived communities. The call for NHS health checks has been criticised and welcomed. The inevitable remark that this is extra labour for hardworking staff to keep the worried middle class satisfied is frequently heard, while others see this demand as being a great opportunity for reaching people before they descend into preventable chronic disease.
There are no surprises within Our health, our care, our say, simply a longwinded description of what we were expecting, telling us how primary care staff are achieving wonderful health successes with local people. A time-table has been set, however, for these actions, so there is some clarity as to what must happen and when.
During 2006 the NHS life check system will be developed and PCTs will be invited to engage with a national procurement exercise aimed at getting a significant number of alternative providers into primary care. A national bowel screening programme is to be developed, and decisions will be made on the future of community hospitals during the next 12 months. Other work includes getting systems and skills right for effective commissioning, making tariffs work and a new project to reduce A&E admissions by a mere one million patients!
In the meantime, we have to contend with major PCT and SHA reconfiguration - and achieving the highest priority of all without damaging patient care, which is getting the NHS out of the red!