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Primary care blog: Singing the praises of community health services

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'Primary care expert Lynn Young on why community health services are a reason to be cheerful'

‘What shall we do with the drunken sailor?’

And, more importantly, what shall we do with community health services?

Many bloggers who happen to be community-flavoured nurses will well remember that fateful day in August 2005 when Sir Nigel Crisp, then NHS Chief Executive, sent a letter to all primary care trusts ordering them to remove their provider function to concentrate solely on commissioning.

This one letter sent most of the English NHS into panic mode, which was not good for the health of either staff or patients.

King's Fund chief executive Niall Dixon described this decision as one which threw community health services (70% of which is nursing) into organisational oblivion.

And this is the point: OK, message received, PCTs need to be world-class commissioners, but where on earth are the community services to go? Who wants them? And who has the talent and courage to take them on?

In the following months, fresh statements emerged from the DH telling PCTs that they could keep their provider function, as long as this was in the patient and staff interest.

More recently the call has re–emerged, and it seems that April 2009 is the time for all PCT provider services to be let loose once more. But, this time it is different as we have a clearer view on options, which seem to be:

  • Social enterprise.

  • Arm's length services.

  • Alliances.

  • Community foundation trusts.

Of these options my favourite, thus far, is the community foundation trust, which I have great hope for in the belief that this is the organisation which will raise the profile, status and power of the community.

Community health services have always pulled the short straw in terms of resources and clout, and this we need to change. The Darzi reforms bring reasons for being cheerful, despite credit crunch and banks without cash.

Public health is in great need of renewed vigour and we need to extol the virtues of the wonderful care which can be provided within peoples’ homes. The nation has to be more successful at preventing people from needing hospital care and suffering the misery of long-term conditions.

Good health emerges from cohesive communities, where people live harmoniously and understand what it takes to enhance general well-being.

My belief is that, along with the foundation requirement to have both strong public and staff engagement, and its ability to work along side local government, the community foundation trust model is my most optimistic one.

We now have six community foundation trust pilot sites in place. They will surely be scrutinised, as all pilots are, but they need our support too. We are living in tricky times and can safely guess that the pressure will be on to spend public funds wisely and with the best possible outcomes.

So, let’s turn the world of healthcare upside down and celebrate our budding CFTs in the belief that the good people working within them will have the essential courage and energy to focus on:

  • public health;

  • the use of social marketing techniques to ensure genuine public engagement and improved life styles;

  • the development of a creative and imaginative workforce;

  • finding the courage to do things differently then from the past.

And we wish our CFT friends the very best of luck…

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