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Doubt Cast on Health Scheme for the Elderly
By John Carvel, The Guardian
England
February 4, 2005
An American healthcare corporation with close personal links to Tony Blair was last night embroiled in a row about its work for the NHS in England.
The British Medical Journal cast doubt on the effectiveness of the Evercare programme, a scheme to provide extra care for older people at risk of emergency admission to hospital. It said government plans to adopt this approach "may be based on misleading data".
Evercare was developed in the US by United Health, a $28bn (£14.9bn) corporation based in Minneapolis. Simon Stevens stepped down as Mr Blair's senior health policy adviser in May to become the company's vice-president and head of its operations in Europe.
The Department of Health became an enthusiastic supporter of the Evercare approach after being shown evidence from the US that it reduced emergency hospital admissions of frail older people by 50%.
John Reid, the health secretary, said in June that he would recruit 3,000 community matrons by March 2007 to provide targeted support for the most vulnerable over-65s throughout England. United Health was in the running to win contracts to manage the scheme, in competition with other companies offering similar packages and the NHS's own in-house teams.
But an independent review of the nine areas where United Health tested the scheme in England reported today that it was unlikely to cut hospital admissions by more than 1%.
The review, commissioned by Mr Reid's department, found Evercare improved the quality of patients' lives, but would not have the expected benefit of halving pressure on hospital beds.
Researchers from Manchester and Sheffield universities warned that an apparent reduction in admissions was illusory, because most patients got better with or without Evercare intervention.
Martin Roland, professor at Manchester and spokesman for the research team, said: "The type of service being provided by Evercare in the UK is very different to the model in the US that found a 50% reduction in admissions, and so we think it unlikely that similar reductions could be achieved in the UK."
The BMJ said: "Government plans to use community matrons to help keep older people out of hospital may be based on misleading data." The plan to transfer 3,000 district nurses and other staff into this work "might leave gaps in the delivery of other community based services".
The Royal College of GPs said: "This vindicates our long-running concerns over community matrons and what seems to be a growing trend towards fragmentation."
Richard Smith, chief executive of United Health Europe and a former editor of BMJ, said the evaluation showed Evercare brought considerable benefits to patients and carers.
The company was hampered by "primitive" information systems in the NHS, which made it difficult to identify the frailest older people. With better targeting the reduction in hospital admissions would be more than 1%.
John Hutton, the health minister, said: "Evercare is just one of a range of different models that we are learning from. We are confident that our model is the right one for the NHS."
David Colin-Thome, the primary care "tsar", said: "There is nothing in this research to make us have second thoughts about the strategy. But I suspect most trusts will say they don't need to pay American providers to run the scheme because they have the building blocks in the health service already."
The health department paid United Health £3.4m to run the nine pilot schemes and contributed £648,000 to primary care trust costs.
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