Published: 14/03/2002, Volume II2, No. 5796 Page 23

I read with interest your article about winter-pressure initiatives to avert beds crises ('Breathe easy', 10 January). I was astonished to find no mention of innovative specialist home care services for acutely ill patients in at least four districts in England, Scotland and Northern Ireland.

Teams of intravenous therapy nurses, each with specialist skills, are increasingly being sought to care for acute patients undergoing a broad spectrum of treatment.

These services are provided to the NHS in Southampton, Aberdeen, Northern Ireland and Newcastle, among others.

The National Association of Primary Care's annual conference discussed one such service in Southampton which saved 2,500 bed-days in 12 months and£500,000. The main winter problem at Southampton General Hospital was identified as acute respiratory admissions. Such patients stayed in hospital on average 10 days. The project reduces admissions and speeds up discharge, but is also associated with improved quality of care and high patient satisfaction.

When patients go home they are supported by a private nursing company, Hospital at Home, to avoid fallback on primary care.

Patients remain under the clinical responsibility of the centre's consultant, with the home care nurses providing feedback.

The project is a shining example of collaborative care.

Professor David Price, a GP in Norwich, has described the Southampton service as the 'nirvana' of healthcare.

Home care, once considered a panacea but when confined to local health boundaries found to be uneconomic, is now enjoying a renaissance in the form of independent sector companies.

They have developed new economies of scale by providing national coverage as well as a strong local presence.

NAPC vice-chair Dr Greg Wilcox has said many winter pressures occur in primary care and should not be ignored. He called for long-term approaches, and mentioned that rapid-access schemes could improve the interface between primary and secondary care - and save GPs a huge amount of work.

It is time we took another long hard look at the potential for intermediate care collaboration in this way.

Ruth Poole Nursing director Healthcare at Home Burton-upon Trent