Published: 10/02/2005, Volume II5, No. 5942 Page 3

The Evercare model of intensive case management for the vulnerable over-65s is looking increasingly troubled.

Independent research shows that the pilots have had little effect on cutting admissions, despite political and management efforts (news, page 7).

Even with 'favourable assumptions', the authors claim that emergency admissions in the pilots are unlikely to fall by more than 1 per cent. Early concerns that US experience in nursing homes could not be compared with UK community projects seems to have been borne out.

Even expanding Evercare to cover all vulnerable 65-year-olds, the researchers say, would only cut demand by 6 per cent - and that would require more than double the number of specialist nurses that the government has allocated in its plan for community matrons.

One problem is the criteria used to select patients for case management of 'two or more emergency admissions in the previous year'. This is apparently not a good guide to subsequent demand on services.

Lise Llewellyn's column in last week's HSJ (Opinion, page 17) is an indication that there is still strong support for the ideals behind case management among NHS leaders. However, this is being severely tested by a growing body of research. For those working in acute trusts, fears that they will lose funding without enjoying reduced demand must be stronger than ever.