The community care chest is running out of cardsBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5067 (Published 13 August 2014) Cite this as: BMJ 2014;349:g5067
All rapid responses
Nigel Hawkes quite helpfully highlights some of the challenges facing community care in England in his article. It is however helpful to share some context.
First, when he writes that the transfer of community services to current providers were complete by April 2011, while this is technically correct, it does not accurately reflect the full picture. The difficulty in untangling several complex contracts and services that had been run together in primary care trusts, meant that several ambiguities remained well after this date.
While community care organisations were still trying to settle into their new roles following the full separation of the commissioner-provider functions of the old primary care trusts, they were then confronted by additional complications occasioned by the transfer of responsibility for commissioning some of these services such as school nursing and aspects of health visiting to NHS England and local authority public health following the implementation of the Health and Social Care act in 2013.
The impact of these additional complications, at a time when these providers were also facing a shift towards more community based care, against the backdrop of massive organisational change in the NHS and unprecedented pressure on local authority funding, should not be underestimated.
Hawkes also appears to suggest that the Labour Party policy of giving responsibility for commissioning community services to Health and Wellbeing Boards is at odds with its "no-privatisation" message, given that local authorities are "among the most enthusiastic in tendering services out" However, given that the membership of the Health and Wellbeing Boards, while led by local authorities, also includes representatives of the Clinical Commissioning Groups, and NHS England, and in some areas, also include voluntary sector membership, and given that the emphasis in Health and Wellbeing Boards is on collaborative working., it is not necessarily a given that the local authority viewpoint will hold sway if these powers are indeed transferred to Health and Wellbeing Boards
Competing interests: No competing interests