Hospital admissions cut plan 'risky'

Busy ward Image copyright Science Photo Library
Image caption Most beds are occupied by relatively small numbers of patients who stay a long time, says the Nuffield Trust.

A £3.8bn scheme to cut hospital admissions in England and treat more people at home is risky, and "overly optimistic", health researchers warn.

Writing for the BBC News website's Scrubbing Up column, Nigel Edwards from the Nuffield Trust says the Better Care Fund, due to start in 2015, could even lead to more hospital admissions.

He says cutting the length of hospital stays would be more effective.

The government says pilots in 14 areas are already working well.

Mr Edwards says there is a proportion - perhaps around 15% of hospital admissions - who could be cared for in the community if GP and nursing services were improved.

Then, he says, there are a number of patients who may be admitted to hospital for a day or two and, while they could be cared for at home, the diagnostic and expert resources needed may well be the same.

He says the real issue is about those patients who remain in hospital for longer.

Care elsewhere

Writing in Scrubbing Up Mr Edwards says: "Most beds are occupied by relatively small numbers of patients who stay a long time.

"In fact, in medical wards 10% of the patients that stay in hospital for more than a week use over 71% of the beds.

"More can be done quickly by reducing patients' length of stay.

"A large proportion of patients could be more effectively cared for elsewhere. This will require better social care, community services and new types of care."

The Foundation Trust Network, which represents NHS trusts which look after their own finances, said the fund was a "step in the right direction" but warned it carries "significant risk that needs to be managed".

Greatest need

Sir Merrick Cockell, chairman of the Local Government Association, said local areas piloting the fund were already going "above and beyond" what had been expected.

He added: "Most areas are now confident they will be able to provide services seven days a week, identify a lead professional for those in greatest need and use patients' NHS numbers to share information."

Sir Merrick said: "Increasing demand means that councils need an extra £400m each year just to maintain services at current levels.

"However, the BCF was never intended to solve the issues related to distressed health economies.

"The Better Care Fund is not a quick-fix that will solve the problems of the health and social care system overnight and it is short-sighted to expect the BCF to payback results in its first year.

"It is the opportunity to transform and improve the lives of those using health and care services over the medium and long term at a lower cost."

Health Minister Norman Lamb said: "The Better Care Fund isn't just about cutting hospital admissions - it's about reducing the time people spend in hospital, having services closer to home and preventing people from getting ill in the first place.

"It's a new joined-up approach which will transform patient care."

He added: "No-one said it's going to be easy, which is why we are working closely with local areas to get their plans for integration right.

"But when we do, patients will get better care in the community and the NHS will be able to focus its attention on those who need it most. "

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