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Home care 'to cut NHS deficits'

Heart patients could be treated at home

The government hopes to cut hospital deficits in England by reducing the number of emergency admissions for chronic illnesses.

The health secretary is set to announce patients with illnesses like asthma and heart disease could be better cared for by community nurses in their own homes.

The measures are intended to save the NHS more than £400m a year.

But nursing leaders said ministers must first ensure staff levels are adequate, which will require further funding.

""We're very supportive of care moving from the hospital to the community but there's got to be the capacity,"" said Dr Beverly Malone, general secretary of the Royal College of Nursing.

""We're talking about a number of health visitors, a number of school nurses, a number of community matrons and practice nurses, and we're talking a good several hundred at least. It's not a cheaper alternative.""

It is staff costs that have contributed to the record overspend of up to £800m predicted for NHS hospitals in England this year.

The problem has been caused partly by more expensive drugs but mostly by a big increase in wage packets, the cost of which the government admits it underestimated.

Advice up front

The NHS spends £1.3bn a year on admissions for patients with 18 common conditions. Those in this group can be admitted to hospital three or more times in a year, costing up to a quarter of a hospital's expenditure in some regions, according to the Department of Health.

Some 5.2m Britons have asthma

In Monday's announcement, Ms Hewitt will say that if unplanned emergency admissions can be reduced by 30%, hospitals could plan their services better - with potential savings averaging almost £2.5m for each primary care trust.

Asthma UK's chief executive, Donna Covey, said it was important to give sufferers better information when first diagnosed. Personal action plans help asthma sufferers manage their disease, yet fewer than one in four of the UK's 5.2m sufferers have one.

""It takes 20 minutes on average for a health care professional to talk somebody through an asthma action plan, but what you get back in that is fewer hospital admissions, fewer unexpected attendances at the GP.

""One of the things we need to see is ways in which people get more time up front so they're taking up less time and less money and less of their lives further down the line.""

Job losses

On Friday, a hospital trust with a £17m black hole announced it was cutting 1,000 jobs. Responding to this news, Ms Hewitt rejected claims that this indicated patients would suffer because of the cash crisis.

She said efficiency savings, such as reducing administration costs and increasing the number of day operations, could be made without affecting patient care.

Ministers have already said that NHS trusts are to be rated separately on financial management, in addition to patient care, as part of measures to tackle those using resources poorly.

8 Replies

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  • Where do you start with an article such as this. Intital reaction must be that it is preferable for people to be treated at home, where it is safe and practicable so to do. Reading through the article, the hospital deficit may well be reduced by these measures but there would be significant cost in expanding the community services in a variety of specialities, for example cardio and respiratory, not only nursing staff but also P.A.M.S (physios and O.T'S ETC). With regard to the overspend caused by big pay rises for nursing staff, must have missed mine!!! Nurses pay is still not consistantly on a par with other professions. Very few nurses do it just for the money. I agree that many more people should have personal action plans, for thier asthma and education does play a large part in reducing hospital admissions. The feeling I get from browsing this site is that the vast majority here do have these plans and can and do adjust their medication as necessary and for them hospital admission is a last resort (unless you can set up an intensve care suite in your dining room!!)

    Regarding the last paragraph, if 1000 jobs can be cut without compromising patient care, were these posts necessary in the first place. There are many N.H.S. staff who firmly believe that the service has become top heavy with administrators and managers

    These views are personal.

    Look forward to more posts on this subject.

    Pat

  • Well I have to say that for one it wouldnt really affect me as I flatly refuse now to go to hossie unless I am in dire need (Personal stubborness and a consultant who understands why I wont have direct access policy)!

    But the hospital trust in question that has announced 1000 job losses happens to be University Hospital of North Staffordshire which is the hospital I goto (13 to 14 miles from us)!

    I got no idea where they want to cut jobs from as nurses are in short supply as it is at the hospital!

    But I know that unless care facilities in the community are improved in this area drastically then this care in community is not gonna affect ALOT of the asthmatics I see when I get admitted!

    Does the health seceratry actually know anything about admissions for asthma at all!

    If she did she would know how serious asthma is if it requires a hospital admission!

    I cant honestly see it being safe too fulfill what she wants!

  • I know that a lot of people on these forums are 'expert patients' who pretty much know how to manage their asthma better than most doctors, and who only go to hospital when really have to, so I don't see where this would help.

    For the rest, I don't think that just throwing more nurses into 'community care' is going to help (aside from the question of where they come from). My perception is that it is a lack of specialist expertise that is a problem. We already have 'asthma clinics' run by generalist nurse practitioners who dont have specialist training in asthma and don't do much other than check inhaler technique. I think there is a danger that this could end up in more emergency admissions and/or longer admissions - if people are encouraged to seek help in primary care and dont get referred to specialists so never really get proper managment, or put off going to hospital until things get really bad. Action plans and self management are all very well, but when it is more than a one off blip you need someone who knows what they are doing, and can do more than just write a one off prescription for a coure of pred.

    Incidentally, has anyone come across a GP with Special interest (GPwSI) in asthma? I thought GPwSI were supposed to be the big hope for reducing buden on hospitals, by providing specialist expertise in primary care. If that could save the wait for a hospital appointment (while you are going downhill and getting nearer and nearer emergency admission point), I can see that helping.

  • What would really save the health service money, would be to have people who retire stay retired. At the moment when you retire on full pension, you can come back to the same job you have just left and do it say..a few days a week on full pay. This to me is a ludicrous state of affairs. But I know of several who have done this very thing. Fine if you are a top person in some speciality but for secretaries and other ancillary staff, its just daft. I say this as a secretary myself.

    Course I may be just a touch huffed as every post I ever applied for on the admin side was filled internally and sometimes by someone JUST NOT LEAVING.

  • I think it might work. But what needs to be done first is the gps and gp asthma nurses need to realise that they need to explain and come up with an action plan, i know some do this but not all do and attacks ending in a&e or being admitted.

    Im lucky i havent been admitted yet. But if my gps asthma nurse does do an action plan and help me control it i could end up in hospital due to my asthma not that my hospital is good

    Amanda

    X

  • As long as we get adequate care. I am not happy about the service in the community. As long as people do not sufffer or die sdave all the money in the world.

    Gill

  • Before I say anything, I should point out that I am fortunate in that my asthma has never, so far, required hospital treatment, so I'm looking for information as much as anything else.

    From what I read on this forum it is very evident that the patients who are unfortunate enough to be admitted to hospital on a regular or semi regular basis have a thorough knowledge of the best way to treat their condition and use hospital as a last resort when all else has failed. My question is, can these very ill patients be adequately treated by a community nurse popping in for 5 minutes a couple of times a day? Even assuming each patient was rationed to 15 minutes twice a day (just guessing) and taking into account the time it would take to travel to each one, would it be practical for a nurse to see more that about 10 or 12 patients per 8 hour shift? In which case, how many more community nurses would be needed to implement this plan? And how much would it cost?

    As I said, I've not found myself in hospital so I probably know about as much as the health secretary does. I'm interested in finding out more - is she?

  • i doubt she does annista.

    I am fortunate i dont go to hospital with mine but i know i should sometimes but my local hospital is rubbish. But i personally have been let down by my gps

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