Intended for healthcare professionals

Observations Body Politic

The community care chest is running out of cards

BMJ 2014; 349 doi: (Published 13 August 2014) Cite this as: BMJ 2014;349:g5067
  1. Nigel Hawkes, freelance journalist, London
  1. nigel.hawkes1{at}

Will the end of many of the current contracts provide a chance to reinvigorate the sector?

Most people blame the present problems of the NHS in England on its bungled reorganisation by the former health secretary Andrew Lansley. But while the Health and Social Care Act 2012 may deserve its place as top bungle, it’s a close run thing with Transforming Community Services, one of Labour’s last acts in office before it was voted out in 2010. Community services in England were certainly transformed but not in a good way: the result is sad, if you believe in the vital necessity of these services. Join a fairly small club if you do.

And while it’s often claimed that Lansley was driven by ideology, Transforming Community Services really was. Service commissioners couldn’t be providers, so they were instructed to rid themselves of their provider arms: health visitors, district nurses, physiotherapists, chiropodists, providers of contraception and sexual health, and sundry others. GPs think the right place for many of these services is in primary care. Acute care trusts think they ought to be integrated with hospitals. Both can make a case, but rather than doing one or the …

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