Reconstructing an Image for the Twenty-first Century

Abstract

Towards the end of the 1990s, government White Papers on Health (DoH 1997, WO 1998) signalled a shift in the focus of health care provision away from services provided in hospitals towards preventive care services provided in community settings. Frameworks for health care provided by this policy devolved the responsibility for identification of health and social care needs, and the provision of services to a local level, making Primary Care Groups (England), Local health Groups (Wales) and Local Health Boards (Scotland) responsible for planning and delivering services responsive to people’s needs. An emphasis on the importance of collaborative care raised the hopes of community nurses that the focus on medically-orientated cure would give way to a care-orientated model of intervention, and that they would have at last an opportunity to move away from the oppression of medical and managerial domination of their roles. However, guidance as to the composition of collaborative PHC structures soon made it plain that medical domination had not been weakened. Whereas representation of nurses was stipulated in these documents together with local authority, health authority, pharmacist, dental practitioner, optometrist representation and lay people, these representatives were far outweighed by the number of doctors that could be appointed. These developments have led sceptics to comment that the nursing contribution to health and social wellbeing is not valued or understood by other professionals or even by nurses themselves (Vaughan 1999).