From next month Primary Care Trusts will become responsible for three quarters of the NHS budget amounting to 46 billion pounds as they take on the responsibility for commissioning treatment for local patients. The shift in the health service balance away from acute hospital services is partly because medical advance is moving towards primary care and also because the increasingly ageing population will have conditions better treated in primary care. In addition, as patients are given more choice about treatment facilities, they will need to rely more on doctors and nurses in primary care for advice. Health Secretary Alan Milburn said: “The Government wants to see prevention and treatment expanded in primary care.”As medical science converts life threatening diseases into chronic conditions the need to treat the frail and elderly near to home increases. The latest census showed that 18% of the population, nearly 9m people, have a limiting long-term illness such as arthritis. The number of people in the UK over 60 will grow by one third up to 2021. The challenge of chronic disease is set to grow over the years to come. This calls for greater emphasis on expanding primary care services so they can work more effectively in partnership with patients.
Partnership working between local councils and Primary Care and NHS Trusts has been boosted with the creation of the Integrated Care Network. Health Minister Jacqui Smith said: “The Integrated Care Network is key to developing more local partnerships, which will ensure that the people who rely on care from both health and social services get a better deal. The partnerships will focus on many groups including children, older people and the disabled, who will have experienced problems in receiving joined up services in the past.”The Integrated Care Network will support all those who are trying to mesh together local social services and health. The new partnership will also help local councils and the NHS to use their resources more effectively and will mean less duplication and fragmentation of services. This will result in a much better standard of care and support for the people who rely on those services.
By Lourdes Torres and Vicente PinaIn the 1990s, a number of EU countries adopted New Public Management techniques to restructure their public sectors. Countries have been widely ‘deconcentrating’ (moving delivery away from the center) and ‘externalizing’ (using the private sector, either totally or in part) to deliver services. The authors chart the extent of this change and highlight some of the problems – for example the difficulty countries are experiencing in developing value for money audits. The article questions whether current methods of delivery and audit are appropriate for 21st century public services.
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