A report outlining the future of community health care across Kennet and north Wiltshire has just been published. JILL CROOKS and CAMERON RAMOS spoke to chief executive Barbara Smith about what the changes will mean for patients and carers.

KENNET and North Wiltshire Primary Care Trust has revealed its plans for future health care across the county this week.

The proposals aim to plug the £10 million gap in the trust's annual budget by 2006, and are due to be ratified by the trust board today.

They show a major overhaul of the way patient care will be provided by the trust.

The trust has earmarked a £2 million saving in community services, a £5 million cut in the budget to reduce waiting times for patients, and £1.5 million reduction in the amount spent by GPs and nurses in prescribing drugs and treatments.

Savings in management and support services, and the running of health premises are estimated at £1.5 million.

Trust chief executive Barbara Smith said the plans were exciting and would focus on providing a better, more equitable service to patients.

"We are talking about providing our services in a different way. We are trying to provide as good a uniform service as we can afford," she said.

At the centre of the proposals will be a move to reduce bed blocking in acute hospitals, by reducing the number of patients in community beds who are ready to go home or to their choice of nursing home.

Half the £10 million will be saved by reducing the £13.7 million budget the trust predicted it would spend to reduce the current waiting times for in-patient and out-patient care by £5 million.

The present waiting time is 12 months for in-patient care and 21 weeks for outpatients. Mrs Smith said taking people out of acute hospitals and improving services in the community, including in the home and in community hospitals, would reduce these times.

To save £2 million on community services greater emphasis will be placed on the community hospitals at Chippenham and Savernake for specialist care and minor injuries cover.

Intermediate beds will be reduced with more money spent on providing 24-hour care in the home.

Critics of the plans have raised concerns about recruiting staff to provide 24-hour home care and are worried the shift of emphasis will place more pressure on the carers.

Mrs Smith said none of the initiatives would take place until alternatives were in place.

She said: "We will need more nurses and carers in the community.

"If we are not able to get those services up and running we won't close the beds early in the programme."

But the future of maternity units has still not been decided. A survey of 1,000 women will be carried out to assess whether units at Malmesbury and Devizes can be expanded.

No decision will be made until July, but with current savings more than £800,000 short of the amount required from community services, Mrs Smith admitted savings would have to be made from maternity services.