UK government proposes health action zones

The UK government plans to concentrate special efforts on several health action zones where it believes people's health can be improved by better integrated arrangements.

The health secretary, Frank Dobson, told the NHS Confederation last week that the proposal would be spelt out in a white paper in the autumn. He envisages that within the zones everyone responsible for delivering NHS care-including health authorities, trusts, GPs, nurses, health visitors, and pharmacists-would be brought together “to develop a health strategy in partnership with local authorities, community groups, the voluntary sector, and local businesses.” He warned that the funding would have to come from within existing resources.

The chief executive of the confederation, Philip Hunt, said that the idea of action zones was of “enormous significance.” “What we are talking about here is an attempt to pull everyone together in a locality and get them committed to making radical changes. We have got to get on with it because unless we do I don't see any ways of squaring the resource circle.”

The health secretary believes that action zones would eventually result in fewer, more focused health authorities and fewer NHS trusts. He pointed out that some illnesses needed a highly specialist comprehensive range of services which could be provided only in a limited number of centres. But if hospitals were to close he promised that people in the locality would be asked for their views on proposals to improve services. “The NHS must treat local people like adults, not patronise them or suggest that officialdom is simply going through the motions of consultation,” he said.

Earlier this month the BMA concluded that reducing the number of hospitals in a region would be feasible but “the political consequences would be considerable” (14 June, p 1714). A report from the Senate of Surgery of Great Britain and Ireland has also proposed that some hospitals should close and others be reorganised to concentrate surgical skills and minimise the risks to patients. The senate, which represents the royal colleges of surgeons and their specialist associations, says that surgical units in short stay hospitals should serve populations of 500000, about twice the present average. The report's chief author, Mr Charles Collins, a consultant surgeon in Taunton, said: “It might be ideal to halve the number of hospitals, but we are alert to the political implications.”

The government is to invite applications for 20 primary care led commissioning pilot studies to begin on 1 April 1998. They will be based on GP commissioning groups recognised under the fundholding regulations and with access to a prescribing budget. Applications should be submitted by 31 July. The government hopes that the pilot studies will cover areas where there has previously been low GP involvement in commissioning.