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Transforming community services – for the worse

Jobbing Doctor is appalled at how managers are desperately pushing through fundamental changes to local services at breakneck speed

When you are as old as the Jobbing Doctor, you have seen most things come and go. Various initiatives pass us by, and often contradict themselves.

We weren't diagnosing depression enough at one point so we were encouraged to look for it. Then we were told some years later that we were diagnosing it too much. I dare say in a few years we will be back to not diagnosing it enough. Plus ça change.

Some things are changing, however, and irrevocably so. I would love to be able to say that the latest Government initiative is going to improve things, but bitter experience over the last 30 years suggests to me that the phrase ‘Government initiative' is an oxymoron.

The latest upheaval is to do with changing the district nursing and other services. We have had a document sent out from the Department with the title ‘Transforming Community Services'. This implies that things will be better at the end of it than at the beginning. They will be different, for sure. I'm pretty sure that they will be worse.

I have had a look at this document, in my role as a senior figure in NHS Dullsville (as the old Dullsville Primary Care Trust has now been renamed), and it is a suggestion that NHS Dullsville should no longer run services such as district nursing, community midwifery, physiotherapy, speech therapy, chiropody etc, but they should be run by somebody else.

Now I've never thought that the PCT ever were terribly good at running these services. However, we have the worrying prospect of them being taken over (either piecemeal or wholesale) by the local hospital trust, or by another provider (by this they mean a private organisation) or one or two other options.

This is a really important change that needs to be thought through: we need to take a view of where community based services are moving to, and what we want from them. The Government is talking about one-to-one community based cancer nursing services as one of their new ‘ideas'; although this is in principle a good idea, the district nursing provision needs to be integrated and moved to deal with all important illnesses in the community, such as dementia and COPD.

I have been presented with the paperwork yesterday at a meeting, and we have to make a decision within six weeks. Six weeks! A fundamental change in the way that a key group of services in the NHS is to be decided, arbitrarily it seems, in six weeks.

This is being pushed for by an organisation known as NHS Grimplace (as the Grimplace Strategic Health Authority used to be named). This organisation is the local enforcer for the Government, and they want it all decided before the 1st April 2010.

There is a real pressure on local chief executives to have decisions ratified at breakneck speed, determining the future of many thousands of loyal and hardworking staff in a rushed process that smacks of political desperation. The underlying agenda, of course, is the opportunity of the robber barons in the private health industry to come in and make a commercial killing.

The private sector do not care about quality. They do not care about loyalty. They do not care about hard work. They are only interested in profits for their management, board and shareholders. If this results in private takeover, then we will see the out-of-hours catastrophe repeated over and over.

It is not about getting the right decision, it is about getting a quick decision. Before the election.

Badly done.

Jobbing Doctor is appalled by how managers are pushing major changes to local services at breakneck speed