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Saturday 23rd June 2018

Shifting healthcare into the community

13th January 2009

Mark Goldman, chief executive of Heart of England foundation trust, on the slow shift of healthcare into the community.


Despite the efforts of primary care trusts, the movement of healthcare from hospitals into the community is not happening.

No primary care trust effort has been spared but as yet there is no significant dent in hospital activity.

Bolder observers say give it time, let’s see what happens with Lord Darzi’s review and his polyclinics. Others suggest there is an "18-week bulge" working its way through the system.

A good area to focus on is A&E, where activity continues to rise.

It was eight years ago that the judgement was made that patients wanted as much healthcare as possible managed outside of hospitals as part of then health secretary Alan Milburn’s 10-year modernisation plan.

There have been various reviews since and alternatives created to support care in the community such as NHS Direct, walk-in centres, extended GP hours, minor injury units and polyclinics.

But still people turn up at casualty, though they are now quite different places, changed by the 98% four-hour wait target.

Resources and attention has been driven to A&E, with serious analysis on tracking patients through the departments.

What lies out in the community does not have that and patients are now exercising their right to choose - and selecting A&E.

Soon the NHS will have a choice with the public as the arbiter.

"Either the public will switch their allegiance to community services or financial pressures will begin to erode the rationale for these newly-established underused alternatives."


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