Better Health ,Better Care - Best Value

This is the shortest section in the document, but perhaps the most important. It is all about money; how it is being used at present, and how it could be used better. It also looks at staffing and the spread of services between acute care and primary care.

This is a section that can be read in a number of ways. For example what exactly is meant by this phrase, 'Challenge traditional boundaries between public sector organisations, sharing premises and resources with other organisations where this makes sense.' Does this mean sharing premises and resources with private companies or does it mean sharing with voluntary organisations, such as Maggies or St Andrew's Hospice? And if you share your budget with a private company and it wastes it, how accountable are they going to be? As I said in the previous post, private companies that spend public money, need to be held accountable in the same way as everyone else. That means that information on their budgeting should be publicly available, not filed away under 'Commercial Restriction'.

Further on, the document states, 'Use the contractual levers at our disposal to ensure that patietns and the public purse get the best possible deal from private sector suppliers.'
We should start to look at changing the rules regarding refinancing of PFI debts. This is a practice where the debt is sold onto a concern that offers the loan at a lower rate of interest; millions can be made from this. But the millions go into the shareholders pockets, not those paying the debt.

One important area that is not discussed, is the relationship between the NHS and Social Work. If, as the document states, they want to shift the balance of care from hospital to community based services, then it has got to have an agreed way of working with the local authority. Central government has also got to look at a way of allocating a budget for community care that involves both parties. Primary care budgets in the NHS have a nasty habit of disappearing becuase they are not ring fenced.

This section does touch on staffing issues and perhaps this is a time to consider what kind of model we want for GP practices. If the government does not want private health care providers in GP practices, it is going to have to change the GP contract that allows this option. It is also time to consider how appropriate the introduction of nurse practitioners is in primary care. Nurse practitioners in triage in A&E can ease the strain; if someone can be seen and bandaged, given pain relief and allow a doctor to see someone else, then that is appropriate. But if someone phones up a GP parctice with long term symptoms that could be anything at all, is it appropriate to book them in with a nurse practitioner, as is becoming increasingly common?

Again, in ''Agenda for Change' there are moves to merge the roles of district nurse and health worker. These are two very distinct roles. District nurses do things like wound dressing and 'messy stuff'. Health workers tend to visit families that have children, esp new born babies, and watch out for signs of childhood diseases or abuse. Is blending these two roles advisable?

Finally there is a mention of flexible working hours. This is common sense, especially where care in the community is concerned. Your average care worker is female and has children or a partner that they are looking after. Yet some care companies are considering ending flexible hours for their staff. This would lead to a huge drop-off in available staff. It must be re-considered.

More tomorrow!