title: Policy paradox and political neglect in community health services.
abstract: Community health services (CHSs) have never had a settled organisational existence but the turmoil has intensified since the publication of Transforming Community Services in 2009. CHSs are now beset by three dilemmas: ongoing organisational fragmentation; the extension of competition law and the spread of privatisation; inadequate workforce development and lack of clarity on the nature of CHS activity. This has left the services in a position of policy and political vulnerability. The solution may be for the service to be part of horizontal integration models such as the accountable care organisation, with a focus on locality and multi-professional teams wrapped around patient pathways.
authors.affiliation: Visiting Professor in Public Policy, School of Applied Social Sciences, University of Durham.
authors.forename: Bob
authors.initials: B
authors.lastname: Hudson
mesh_terms: D003152:Community Health Nursing / Q000458:organization & administration*; D003153:Community Health Services / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D018166:Health Care Reform / Q000331:legislation & jurisprudence; D006291:Health Policy / Q000331:legislation & jurisprudence; D006801:Humans; D011057:Politics; D013192:Staff Development / Q000458:organization & administration; D013222:State Medicine / Q000331:legislation & jurisprudence; D006113:United Kingdom; D000078329:Workforce
keywords: Activity measurement; Community health services; Models of integration; Organisational fragmentation; Privatisation