Elderly Health Scheme Criticised
A government-backed health scheme aimed at keeping frail and elderly people out of hospital failed to cut emergency admissions, a study has found. The Evercare scheme began in pilot areas in England in 2003, and was the basis for the community matrons scheme.
But the British Medical Journal study said it failed to cut admissions, length of stays and death rates.
However, the government said “much had changed” since the Manchester University research was carried out.
The Evercare programme was based on a successful scheme in the US, where it cut hospital admissions by up to half.
It used specially-trained nurses to identify and monitor “at risk” older people, with the aim that they would receive treatment before a visit to hospital was necessary, a process called case management.
Nine primary care trusts (PCTs) piloted the £4m scheme, which was run by United Health Europe, between 2003 and 2005.
In 2004, the government announced it was to create 3,000 community matrons, who would perform a similar role to Evercare nurses, helping people with long-term conditions avoid unnecessary hospital admissions.
The researchers from the National Primary Care and Development Centre at the University of Manchester looked at the rates of emergency admission, how long the patient stayed in hospital (bed days) and death rates in Evercare pilot areas and compared them to other areas of the country.
They found that the Evercare programme had no significant impact on rates of emergency admission, bed days or mortality.
Writing in the British Medical Journal the researchers, led by Dr Martin Rowland, said the idea of trying to manage cases in the community in this way was unlikely to reduce hospital admissions.
They add: “Although lessons have been learnt from these initial pilots, such as better ways of identifying high-risk groups, we predict the same outcome from the newly introduced community matron policy as that is based on the same principles as the Evercare advanced primary nurses.
“Community matrons are likely to be popular with patients and increase access to care, but they are unlikely to reduce hospital admissions unless there is also a more radical system design.”
Dr Laurence Buckman, from the British Medical Association’s GPs committee, said: “This case-management system based on the Evercare pilots is already a key element of government community-care policy, but the evidence that this form of care helps the NHS simply isn’t there.
“It would have been wiser to have evaluated case management more carefully before the NHS was forced to take it up.
“Now that we have the evidence we hope that the government will learn from it.”
But Dr Richard Smith, chief executive of United Health Europe which ran the pilots said: “The BMJ paper has many flaws, and it’s hard to be confident about its conclusions.
“It was also unreasonable to expect reductions in unplanned hospital admissions when patients were in the programme for only eight months.
“We agree with the authors, however, that the system needs to be redesigned to include features like 24 hour cover, intermediate care beds and risk stratification of patients.”
Health minister Rosie Winterton said: “Much has moved on, and continues to do so, since the pilots.
“Services are recognising many of the issues raised in the report including the impact of information and the need for integration across services to improve the management and reducing admission of people with long-term conditions.
“The Evercare pilots were successful in identifying patients with complex needs who were previously unknown to the NHS and this success in extra case finding may have affected the rates of emergency admission in the pilot sites.
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