The Association of Community Health Councils says health visitors, district nurses, cancer nurses, chiropodists, community dentists and other professionals are a "low priority" in the market-oriented health service. This is despite government commitment to improving primary health care to ease the burden on acute hospital services.
In many areas, community health services have been run down to a point where they become ineffective, the report says. It warns that demand for these services will increase as Care in the Community takes effect. "[They] are unlikely to be unable to cope with the additional workload imposed by community care unless they receive urgent additional funding."
The report highlights the erosion of community dental services which screen and treat children, nursing mothers and the disabled and which has been cut by 25 per cent since 1982. About 400,000 fewer patients are now being treated.
Toby Harris, director of the association, said chiropody services and speech therapy were also in short supply in many parts of the country.
"The most vulnerable patients will inevitably suffer," he said. A government survey in 1989 found that chiropody was the main service requested by the disabled and people over 75.
The number of school nurses has suffered drastic cuts and there is now only one nurse per 3,000 people. A government report in the 1970s recommended a ratio of one per 2,500.
Other services under threat from lack of investment, include continence advisers and specialist nurses such as psychiatric nurses, community midwives and Macmillan nurses who work with terminally sick patients and those needing pain-relief at home.
n Community Health Services, The Association of Community Health Councils for England and Wales, 30 Drayton Park, London N5 1PB; £8.