US Scheme Fails To Prove Worth In UK
A controversial US health scheme which the government imported into England to keep frail older people out of hospital has failed to cut emergency admissions, according to research in the British Medical Journal. The Evercare scheme was developed by United Health, a company based in Minneapolis with a $45bn annual turnover. The company cemented its relationship with the NHS in 2004 when it recruited Simon Stevens, then Tony Blair’s senior health adviser, as its vice-president and head of operations in Europe.
Evidence from the US showed the Evercare programme was successful in keeping vulnerable older people out of hospital. But the BMJ research has found the version of the scheme adopted in England did not have the same effect. Its findings cast doubt on a government decision to recruit 3,000 community matrons to extend the scheme throughout England.
United Health began testing the Evercare programme in nine pilot areas in 2003. It used computer software to identify the most vulnerable older people and monitored their state of health, intervening when a problem arose.
Before the programme could be evaluated, John Reid, the then health secretary, announced plans in June 2004 to adopt the approach throughout England.
The BMJ report found Evercare was popular with patients and carers but did not reduce the number of deaths or emergency admissions. “Previous research in US nursing homes showed that Evercare reduced unplanned emergency admissions in targeted over-65s by 50%. However, the US version was markedly different to that in the UK. The US version included intensive home nursing care for patients when they became ill.”
The evaluation of the Evercare pilots in England was carried out by the National Primary Care Research and Development Centre and the Universities of Manchester, York, Sheffield and Plymouth. Researchers predicted that the community matron policy was not likely to be any more effective than the pilot schemes.
Martin Roland, the centre’s director, said: “Our overall conclusion was that there was no significant impact of Evercare on emergency admissions, length of stay, or mortality. These results are consistent with…our previous predictions.”
An accompanying BMJ editorial said the study showed there was “sparse” evidence to support this approach to cutting unplanned hospital admissions, which was “a cornerstone of the commissioning plans of all primary care trusts”. Most PCTs are running the community matron scheme without support from United Health.
Richard Smith, chief executive of United Health Europe, said: “We are pleased that patients, carers and staff have been so positive about their experience of the Evercare programme.” Dr Smith, a former editor of the BMJ, added: “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.”
He said Evercare was “redesigned” to work within the English healthcare system, aiming to identify the most vulnerable older people more accurately and provide them with 24-hour nursing cover.