MANAGED CARE United blames low success rate on use of NHS nurses

Published: 10/02/2005, Volume II5, No. 5942 Page 7

The company behind the Evercare model of chronic-disease management has claimed that it could cut admission rates far more dramatically than NHS pilots have done - if it hired its own nurses for the programme.

Last week, research published by Manchester and Sheffield universities found that the 10 pilots of the scheme in England had cut admissions among the elderly population targeted by less than 1 per cent.

Figures from the US showed that unplanned hospital admissions in nursing homes could be cut by 50 per cent, but the US scheme differed from the NHS pilots because extra nursing care was available.

This week Dr Richard Smith, chief executive of UnitedHealth Europe, which runs the Evercare programme, said Evercare could achieve better results if nurses working on the programme were directly employed by the company rather than by the NHS.

He said the programme needed to be 'much more intensively managed' at a local level as part of a wider community care package to match US success levels.

But Dr Smith acknowledged that use of non-NHS staff could be 'politically difficult' in the NHS.

The interim report on the pilots also raised the question of whether the programme was giving the NHS value for money. Mr Smith said inadequate and 'primitive' data from the NHS also contributed to difficulties in identifying the most frail older people.

Manchester University professor of general practice and research team lead Martin Roland said: 'The type of service being provided in the UK is very different to the model in the US... so we think it unlikely that similar reductions could be achieved.' Professor Roland said researchers concluded that even if the programme was scaled up to cover the whole vulnerable population aged 65 and over, 'the maximum possible reduction in emergency admissions ... is around 6 per cent, ' a figure which he described as based on 'highly optimistic assumptions'.

But the report said pilots reported a range of benefits to patients, including improvements to quality of life.

www. npcrdc. man. ac. uk See Comment, page 3.