A New Direction for Community Services in the 21st Century
School of Healthcare, University of Leeds, Leeds, United Kingdom
The National Health Service (NHS) is characterised by the fact that it provides healthcare free of charge at the point of delivery to all UK residents. This level of service provision is associated with escalating costs. In response to this pressure, and others, major reforms to the NHS in England have been introduced at what can only be described as a breath-taking pace. One of the most recently published policy documents is the new White Paper entitled 'Our health, our say: a new direction for community services' which outlines the proposed changes for the provision of NHS community services (DH 2006a). The four broad aims of the new White Paper are to -
- improve health and well-being;
- provide convenient access to high-quality services; and
- support for those with greatest need; and finally
- to place care provision in the most appropriate setting, closer to home (DH 2006a).
Two significant themes evident throughout this document are first, the shift in emphasis upon the community setting rather than the hospital setting for care delivery and second, an increased emphasis on prevention. Extensive consultation was sought with the general public to develop this document with over 40,000 people participating in a range of activities ranging from completing questionnaires to attending a national conference.
The increasing number of people living with chronic diseases such as diabetes and HIV/Aids in both developed and developing countries has been a major driver for these policy changes (WHO 2004). The ageing of the population in developed countries has also contributed to the development of this trend. Such demographic changes are associated with escalating health care costs which are unsustainable in the long term (Battersby & SA Health Plus Team 2005). Moreover health services across the globe have been said to be inadequately prepared to meet these emerging challenges (WHO 2005).
Although the healthcare systems in Australia and the UK are different, they share some similarities. For example, social inequalities in health exist in both (see Morrissey, 2003a and 2003b). In Australia, the life expectancy at birth in 1991-2001 was 56 and 63 years for Indigenous males and females respectively, significantly less than that of male (77 years) and female (82 years) non-indigenous counterparts (AIHW 2006). In the UK, the South Asian population have a higher risk of developing coronary heart disease compared to Caucasian peoples (Smaje 1994). As well as social inequalities in health, both countries (and others) face similar challenges in the shape of an emerging epidemic of chronic diseases; a situation further complicated by the escalation of unhealthy lifestyle habits leading to increasing levels of obesity and physical inactivity.
A comprehensive discussion of the reforms and associated policy is not possible within the scope of an editorial but an overview of selected key initiatives will be provided which may be useful to those responding to similar challenges in health settings across the globe.
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