Health secretary Patricia Hewitt has published a white paper detailing the government's plans for ensuring that health and social care services work together more effectively.

The plans place an increased emphasis on primary care in a bid to free up hospitals to deal with the most serious health problems.

And they aim to provide people with more choice and say over the care they receive in the community.

Stakeholder Response: Commission for Patient and Public Involvement in Health

A spokesman said: "The Commission for Patient and Public Involvement in Health welcomes the white paper’s commitment to a stronger voice for the public and patients but is disappointed it does not indicate how this can be achieved.

"The NHS is undergoing profound changes, some of the most significant since its inception in 1948, and it is inconceivable that such major reforms should be forging ahead without robust structures to ensure accountability to patients and communities.

"Patient and public involvement forums were looking for clarity about their future in the white paper, as well an indication of future arrangements for patient and public involvement and how these will be supported.

"If there is to be further consultation to develop those details, we urge health ministers to use the experience of those with expertise in this area to inform their decisions.

"The white paper is entitled 'Our health, our say'. It is ironic therefore that has so little about how the 'say' is going happen.

"After years of uncertainty we are concerned that public involvement appears to be once again a 'Cinderella' issue."

Stakeholder Response: Amicus

Gail Cartmail, Amicus head of health, said: "We completely support the government’s priorities in tackling health inequalities and boosting the sexual health services.

"Health visitors, school nurses, speech and language therapists, and sexual health advisors are central to implementing the government’s public health policies.

"We are very keen to move forward, but our members in the frontline are being distracted - and their morale is being decimated - by the debate over future organisational structures.

"Health secretary Patricia Hewitt can’t wash her hands of this. She has said that the 2008 deadline for PCTs to relinquish the majority of their provider role is no longer part of the reform package.

"If that is this case, why doesn’t NHS chief executive Sir Nigel Crisp formally rescind his letter of July 2005 that stated PCTs would lose their provider functions?"

"The government must not ignore the financial pressures facing PCTs which have already led to job cuts in primary care, as well as posts being frozen. Unless this is resolved very quickly, the whole fabric of the white paper will be eroded by this financial morass.

"The so-called concept of ‘social enterprise’ is the first big step towards privatisation of NHS primary care services. It will lead to fragmented services, and the prospect of poorer pay and conditions for staff, with the adverse knock-on effects for patients and clients.

"The vast majority of the electorate supports a unified NHS. They don’t support the privatisation of the NHS which will turn into a Californian gold rush for private companies, at the taxpayer’s expense."

Stakeholder Response: Royal College of Physicians

In a joint response the Royal College of Physicians/Royal College of General Practitioners said: "Patients have sent out a clear message during the consultation that they want better co-ordinated health and social care services, delivered closer to home.

"These views mirror those of our important and well-established patient/user groups.

"As bodies responsible for ensuring high standards of medical care, we will respond to this message, and look forward to working closely with the Department of Health in developing new patterns of care that will enable people to have more control over their health and well-being.

"Neither College underestimates the practical difficulties involved in the future reconfiguration of services, particularly while the health service faces a financially stringent future.

"Delivering care in community settings cannot be seen as a cheap option, and the two Colleges in partnership will work on maintaining the quality of clinical care wherever it is provided.

"The implications of the changes for the future of acute hospitals is not clear, particularly the workforce implications, but it is vital that acute hospitals retain a critical mass to maintain their viability and safety during the transitional period.

"In particular, the RCP welcomes the opportunity to work with the Department of Health on the areas with the greatest implications for the future of specialist care - the development of clinical pathways, the urgent care services strategy and the growth in community hospitals.

"Physicians working together across traditional boundaries have a key responsibility to exercise leadership in determining and delivering these desirable changes.

"The RCP also welcomes specific initiatives within the white paper - allowing people with disabilities to have personal budgets will improve quality of life, and improving rapid access to sexual health services is a vital part of the drive towards tackling the rise in sexually transmitted diseases."

Professor Dame Carol Black, president of the Royal College of Physicians, said: "This is a great opportunity for doctors to exercise leadership in the delivery of this new service.

"We look forward to this opportunity of working with colleagues to shape the future of healthcare in this country."

Stakeholder Response: Chartered Institute of Marketing

A spokesman for the Chartered Institute of Marketing told ePolitix.com: "The health providers have to focus on the 'four Ps' of marketing success.

"The right product (or service) at the right price in the right place at the right time backed up by the right promotion.

"If they fail to consider how they’re going to "sell" the product to the right people at the point of need, then the initiative may well add more cost than it saves.

"There is a need for some very serious market segmentation to be undertaken here.

"As we all know, the middle class consumer tends to have a healthier lifestyle anyway and also tends to be more aware about the need for health checks (many can already access these through BUPA and the like).

"It’s the unhealthy "underclass" that tends to the kind of lifestyle that will inevitably catch up with them one day and these are going to be the hardest people to reach and the hardest to persuade to change their attitudes and behaviours.

"Unless we see a real commitment to the effective marketing of these new initiatives we may see a spectacular shop-window display of goods that won’t shift.

"Failure in this area will simply add the cost of the new initiative without delivering any corresponding long-term drop in the cost of provision of health and medical services through this preventative screening and the better lifestyles that in theory ought to result.

"I think that there is real case for ensuring that the people responsible for communicating this have the right skills to ensure that they can take steps to understand their audiences and plan it well.

"Otherwise there could be a lot of wasted money in incorrect targeting and messages that are inappropriate for the audiences."

Stakeholder Response: Which?

A spokesman for Which? told ePolitix.com: "Recent Which? research highlighted the fact that nearly two-thirds of the public and health professionals think that the main priority in health care is involving patients in decisions about their condition or treatment.

"Which? therefore welcomes the white paper as it signals a much-needed commitment to building healthcare services around the patient.

"However, if the government is going to make this concept work, it is essential that patients are involved in discussions to make sure that communities get the services they really need.

"There must also be investment in consumer education to ensure that people are aware of the choices they have.

"The range of treatments on offer can be bewildering and the current lack of such advice means that many people see their GP or go to an A&E department rather than seeking advice from pharmacists and nurses.

"This also means that alternatives such as minor injury units are not always considered.

"Transferring more services to the community and getting GPs to provide more services is great but there must be effective regulation and inspection of these services to guarantee patients receive services of high clinical standards."

Stakeholder Response: Institute of Directors

Geraint Day, head of health policy at the Institute of Directors, said: "We welcome the moves to help bring more resources to bear to augment free at the point of use National Health Service delivery of healthcare.

One of the chronic problems of NHS provision has been the lack of human and other resources to help tackle certain health problems. By having a more diverse range of providers this should help make for improvements.

"It is not only in some locations that health services could benefit but there are some specialities in great need of a boost.

"The government's plans for helping people who want to get back into work and who make up the majority of the 2.7 million people claiming incapacity benefit could also be given new life.

"Many people who are long-term absent from work are in crying need of help from services that cannot and need not provide.

"Many of these people could benefit from the skills and expertise of health and social care providers such as those involved in occupational health and rehabilitation.

"That should benefit the individuals, enterprises and the economy as a whole."

Stakeholder Response: Age Concern

Age Concern England director general Gordon Lishman said: "The government has finally set out a programme for radical reform of community health and social care services in England.

"Older people are the biggest users of health and social care services. Yet for too long little attention has been given to services that prevent illness and allow older people to live independent lives.

"Older people often have to battle to get the services they desperately need.

"We hear of many older carers at breaking point as they do not get the support they need to take a break and older people’s mental health services that are woefully inadequate.

"We welcome the white paper’s focus on bringing together community health and social care services, as older people must be able to access a range of joined-up services in their communities.

"It’s hard to see, however, how the government will realise its vision of integrated services without committing extra money.

"Investment in services that prevent ill health and maintain older people’s independence is desperately needed.

"The government must plug the chronic shortfall in social care funding to develop services that meet the needs of older people in the 21st century."

Stakeholder Response: United Response