Intended for healthcare professionals

Rapid response to:

Education And Debate The hospital of the future

Better out than in? Alternatives to acute hospital care

BMJ 1999; 319 doi: (Published 23 October 1999) Cite this as: BMJ 1999;319:1127

Rapid Response:

role of policy interventions underplayed

Dear Sir

Better out than in? Alternatives to acute hospital care

We do not think that Martin Hensher, et al, have produced a
convincing case that changes in diagnostic and treatment technologies,
rather than policy interventions are the most prevalent force leading to
the substitution of one form of health care service for another.

we assume that this statement meant to refer to alternatives to hospital
care, rather than all health care services. But even here we disagree
about the importance given to policy interventions. The closure of the
mental health asylums led to marked reductions in beds for patients with
mental illness. The policy decisions to increase social security payments
to fund nursing home placements, was the most important factor in the
reduction of long-stay beds for the elderly, and the reduction in length
of stay. The recent asthma campaigns supported by paediatricians and
voluntary organisation’s have led to a marked reduction in admissions for
children with asthma exacerbation’s. The marked expansion of primary care
with the transition of services from secondary care in the last decade has
been an explicit government policy priority.

We do not feel that the
authors have given sufficient weight to the impact of these policy
interventions and their concomitant effects on the use of acute hospital

Yours sincerely

Bernadette Purcell

Specialist Registrar

Simon Lenton

Specialist Registrar

Peter Lewis

Senior Lecturer in
Bio Statistics

Philip Milner

Director of Public Health

Competing interests: No competing interests

03 December 1999
Bernadette Purcell
Specialist Registrar Public Health
Wiltshire Health Authority