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Preventing hospital admission: we need evidence based policy rather than “policy based evidence”

BMJ 2014; 349 doi: (Published 23 September 2014) Cite this as: BMJ 2014;349:g5538
  1. David Oliver, visiting professor of medicine for older people, School of Health Sciences, City University, London EC1V OHB; former national clinical director for older people at the Department of Health
  1. David.Oliver{at}

Politicians push for evidence that supports whatever initiative they back, but formal evaluation often shows such initiatives to have failed, writes former older people czar David Oliver

In July 2014 commissioners throughout England published projections for reductions in urgent admissions to their local hospitals.1 But the size and speed of these reductions were not informed by any credible peer reviewed evidence—they rarely are.

Recent reviews by the Universities of Cardiff and Bristol on admission prevention,2 and by the health think tank the Nuffield Trust on new models of service in the community,3 found that the big and rapid reductions were illusory, once the findings had been peer reviewed and control data taken into account.

Similar annual projections have been made for at least a decade. Yet although we have lost about one third of acute and emergency hospital beds in England in the past 25 years, emergency admissions have risen by 37% in the past decade.4 This farcical game represents a triumph of management consultancy over evidence, and of hope over experience. Local plans are based on how much money commissioners need to “save” on acute activity rather than any realistic expectation of service delivery. Savings are rarely made just by shifting the setting of care even if community alternatives to hospital are available, effective, …

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