The NHS long term plans promise a lot - but will they deliver ?

The government’s NHS long-term plan, recently published, paints a compellingfuture for the future of care for older people, saying that care will becoming increasingly more coordinated and responsive and that, as a result, pressure on hospitals will be reduced and money saved. 

 These promises are nothing new – over the past decade there have been scores of initiatives aiming to prevent unnecessary hospital admissions.  But, sadly, little evidence of success has been found.  An early pilot of one such programme in Cornwall (Living Well), found that this voluntary sector-led care support scheme had the potential to help reduce feelings of isolation in older people, and to increase the productivity of health and social care staff. But do such schemes help reduce hospital admissions?  The Nuffield Trust* analysed data from a range of initiatives nationwide, comparing hospital activity for clients in the scheme with those not referred.  The results found that hospital admissions and costs were actually substantially higher for those referred; and this persisted for well over a year after referral and was quite consistent.  We asked why, and a key hypothesis is that these programmes helped to discover previously unidentified needs, and that the older people at lowest apparent risk of future emergency admission ended up with the highest relative increases in costs; along with tentative signs that some clients involved for some time showed no difference in hospital use. 

 The Nuffield Trust concludes that whilst such initiatives may promote well-being and can enhance services, the government shouldn’t bank on the prospect of significant financial savings without good evidence.  We need to stop being over-optimistic about likely financial benefits, especially from reductions in hospital activity.  Most often, doing more for patients is going to cost MORE, not less. 

 Hence West Cornwall HealthWatch’s scepticism that the 10-year plan will simultaneously save money and reduce the need for hospital care by caring for people in the community instead.  Our concerns include the dire staffing pressures and shortages, particularly in GP practices and community care, currently being experienced.  Without more funding and more appropriately qualified staff, the best plans in the world will flounder and fail. 

 This, and many other issues relating to health and social care in West Cornwall, will be discussed at our Annual General Meeting, being held on Thursday 14th March at 7pm in the Alverne Room, St Johns Hall, Penzance.  Our guest speakers this year are Kate Shields, Chief Executive of the Royal Cornwall Hospitals Trust (responsible for West Cornwall and St Michaels Hospitals as well as Treliske), and Neil Walden, local GP and lead for the Penwith Locality Group (which works to coordinate and initiate primary and community care services).  All our supporters are welcome to attend, and we look forward to an interesting discussion. 

 *Theo Georghiou, senior research analyst, Nuffield Trust