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Treat victims of asthma and angina at home, says Hewitt
By George Jones and Amy Iggulden
(Filed: 20/03/2006)
Patients with conditions such as asthma and heart disease are to be treated at home rather than in hospital under plans to ease the cash crisis in the NHS to be announced today by Patricia Hewitt, the Health Secretary.
Patricia Hewitt: patients could be ‘managed in the community’
She will claim that the health service in England could save up to £400 million a year by cutting the number of emergency admissions and using community nurses to treat patients in their homes.
But nursing leaders said the proposals would not work unless more community nurses could be recruited.
Miss Hewitt will state that patients with conditions such as asthma and angina could be ""managed in the community"" by community matrons rather than in hospital.
""If we could cut these unplanned emergency admissions by 30 per cent, patients would have improved lives, hospitals would be able to plan their services better and the NHS could achieve savings of more than £400 million a year,"" she will say.
According to the Health Department, the potential savings from those Primary Care Trusts that have many more emergency admissions than the average is almost £2.5 million per PCT.
The NHS spends around £1.3 billion a year on admissions for patients with 18 common conditions and this group of patients is often admitted to hospital three or more times in a year. In some regions this can account for up to 25 per cent of a hospital's costs.
The Royal College of Nursing said that numbers of district nurses - the recruitment pool from which new 'community matrons' are drawn - had fallen by 10 per cent since 1997.
There were 12,827 district nurses in England in 2004 - the last year for which figures are available - down by about 1,430. The RCN predicts that this number will fall by 28 per cent in the next 10 years through retirement.
The Government has set a target to recruit 3,000 community matrons by 2008.
Howard Catton, the head of policy at the RCN, said: ""We support the principle of shifting care from hospitals into the community where it is appropriate, but there is a serious issue with staffing.
""We have not got the capacity at the moment to cope with a large-scale shift of patients from hospitals to communities. We need to look at recruitment if this is going to work.""
He said nurses were worried that the proposals would be seen as a knee-jerk response to the financial difficulties of the NHS and did not sit easily with current fears over redundancies.
""They need to know that this is being prepared for properly, and not a cheap alternative.
""It will not save money in the short term anyway, because of the increased need for staff.""
He suggested that acute care nurses threatened with redundancy should be considered for retraining for work in the community.
Nurses' fears were echoed by the British Heart Foundation, which represents sufferers of heart disease.
Betty McBride, the director of policy and communications, said that ""big questions"" needed to be answered and that ""clear evidence"" was needed that patient care would not be compromised.
""People living with the burden of chronic heart disease have specific needs. They are in no position to wait around for the NHS to build up the infrastructure needed,"" she said.
Asthma UK, the charity that represents the 5.2 million asthma sufferers in Britain, welcomed the announcement.
The chief executive, Donna Covey, said that 75 per cent of the 72,000 hospital admissions for asthma could be avoided if people received better advice at home.
Has the recommended delivery of Prednisolone for asthma changed over the last 10 years?
If my peak flow has always been low what will spirometry reveal?
Quit smoking 5 fags a day for 14 years and asthma has kicked off.. 
