Health secretary urges better management of chronic disease

BMJ 2006; 332 doi: (Published 23 March 2006) Cite this as: BMJ 2006;332:688
  1. Lynn Eaton
  1. London

    Better management of patients with long term conditions in a community setting could improve their lives, reduce emergency admissions, and reduce NHS costs, said England's health secretary, Patricia Hewitt, in a press statement.

    The health service could save more than £400m (€580m; $700m) a year if it reduced the number of unnecessary admissions of people with illnesses such as asthma, angina, and chronic obstructive pulmonary disease (conditions defined as “ambulatory care sensitive”). Such admissions currently cost the NHS some £1.3bn a year.

    “Whilst it's important to know the hospital is always there, it's a much better, more stable life for people if they can be treated in the community without the need for so many emergencies,” said Ms Hewitt.

    Her recommendations are based on findings from the NHS Institute for Innovation and Improvement, a special health authority that is charged with improving healthcare delivery. The institute reports that in some regions emergency admissions for ambulatory care sensitive conditions represent less than 10% of hospitals' costs, whereas in other regions it rises to nearly 25%.

    “The potential savings from those primary care trusts [PCTs] that have many more emergency admissions than the average is almost £2.5m per PCT,” Ms Hewitt said.

    But her announcement, which comes at the end of the 2005-6 financial year and as one hospital in Stoke-on-Trent announced plans to cut 1000 jobs to deal with a deficit of £17m, was seized on by the Conservative party.

    The opposition health spokesman, Andrew Lansley, said: “Many times we have urged the government to improve the availability of community services. Only now, with deficits rising, are the government responding with the idea that they will get health care on the cheap.

    “Shutting down hospitals without having put community teams in place just threatens the care of patients.”

    However, the NHS Confederation, which represents the majority of NHS organisations, welcomed the announcement. “Reducing hospital admissions is good for patients and for the NHS,” said Nigel Edwards, director of policy. But he pointed out that there was currently little financial incentive for hospitals to work with primary care trusts to reduce the number of people with long term conditions being admitted.

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