Published: 22/04/2002, Volume II4, No. 5902 Page 4 5

Senior health figures have welcomed the emphasis of the Department of Health's five-year plan, and also some of the suggestions relating to more specific aims.

Chronic-disease management Older people's czar Professor Ian Philp has lent extra weight to the key statistic that 5 per cent of patients take up 42 per cent of hospital bed days.

He pointed out that for older people, the percentage of care taken up by 5 per cent of patients is even higher, at 46 of bed days.

He said achieving the 30 per cent 'target' 'would be quite a challenge', but not 'impossible', and he said work is already underway in primary care trusts taking part in pilot schemes with US organisations Kaiser Permanante and Evercare.

'It is more a case of organisational change than more resources, but the details are something that have to be worked through, ' Professor Philp said.

And he expressed concern that any extra workload was likely to fall on nurses rather than doctors.

British Medical Association consultant committee deputy chair Dr Ed Borman also questioned whether there would be enough nurses to achieve the 30 per cent shift. And he asked whether the primary care sector was yet ready to take on the extra workload.

'This is part of the broader deregulation agenda. One can understand why the government would make these proposals, but we would have concerns. These cases coming into primary care would be more complex'.

NHS Alliance chair Dr Michael Dixon said the 30 per cent target accorded exactly with what his organisation believed could be delivered: 'It is achievable. It is being done in all sorts of ways by having more chronic care in the locality, with more GPs and healthcare professionals with special interests and more consultants in the community as well. It is also about having more careful planning; care co-ordinators and proper case management along the sort of lines we have seen with Evercare.'

Noel Plumridge, a former NHS finance director and a current Chartered Institute of Public Finance and Accountancy health panel member, suggested that while the 30 per cent goal is laudable, it may take 'two, to twoand-a-half years' for change to feed through.

He said: 'The way to do that is to include the whole of the patient care pathway within the paymentby-results system, so it would be necessary to put costs against all treatments in the patient care pathway, including primary care.'

Patient experience Commission for Patient and Public Involvement in Health deputy chief executive Steven Lowden described the direction of the PSAs as 'comprehensive'.

He said the combined effect would be to improve the patient experience.

'It is actually very good in that patient experience is seen as more than rhetoric - something is actually being done about it, which we would absolutely welcome.

Something we would be keen on is that our patient forums are involved in that process.

Patients Association director of policy Simon Williams also welcomed the rise in importance of patient experience.

He suggested that the biggest single 'target' that would improve patients' experience would be to publish performance data.

Mr Williams said the key was 'about outcomes'.

New directions: DoH strategic priorities and the five-year plan

A presentation by Simon Leary, a member of the Department of Health strategy unit, flags up a number of new directions for the department to work towards until 2008.

Its 'key objectives' include ensuring that 'patients are more in control', to 'contribute to the community and the economy'and to 'improve health for everyone, especially the poorest'.

In 'decoding' these objectives, the document speaks of 'priorities', including 'accelerated drive on access to and quality of services', and the presentation list's 'more aggressive access targets', under its 'what's new?' section.

It is a series of graphs and charts showing the impact of chronic disease on the health system that are perhaps the key to the DoH's future direction.

The presentation includes graphic evidence of the much-touted fact that 5 per cent of inpatients account for 42 per cent of overall inpatient days (see graph below) And under a further list of 'priority needs' lies 'commissioning skills', the 'development of chronic- disease management pathways'and ensuring incentives are 'fully aligned'.

This could be seen as a hint that payment by results reforms need to ensure care is not pushed back into the acute sector.