Investment vital for care of long-term conditions

Plans to shift the care of patients with long-term conditions from hospitals into the community could be doomed to failure without a significant increase in funding and staffing levels.

GPs who helped develop the template for such a scheme in Dudley, in the West Midlands, say it is not a quick fix, and that it takes time, clinical engagement and resources to establish it.

The clinicians who pioneered the scheme three years ago worked hard to forge collaborative relationships between primary and secondary care and social services, according to Dudley GP Dr Purshatom Gupta.

Health secretary Patricia Hewitt said similar schemes could cut the number of emergency admissions by 30 per cent a year, saving the NHS £400 million.

Dudley PCT has saved £500,000 on excess bed days and has reduced patients' length of stay in hospital by 32 per cent, while lowering emergency patient admissions.

However, its success could not have been achieved without recruiting and training a number of specialist nurses and case managers, Dr Gupta said.

The availability of these staff is problematic, according to the Royal College of Nursing (RCN).

'We support the principle of delivering care at home,' RCN head of policy Howard Catton said. 'Rolling out the scheme nationally would require a significant investment.

'The key players would be community matrons, or case managers. The target is for 3,000 community matrons by 2008, most of whom would be drawn from the ranks of district nurses.'

However, he added that the number of district nurses had fallen by 10 per cent since 1997, so the workforce issue would need to be addressed.

'We have not been replacing the district nurses who are leaving the profession,' Mr Catton said. 'Add to that the 28 per cent of community nurses we expect to retire in the next 10 years and you can see the problem.'

The DoH's draft delivery framework for the White Paper 'Our Health, Our Care, Our Say', released last week, is also cautious about the potential for savings from the proposals for long-term care.

It acknowledges that potential savings might only be realised in the long term and might only partially or fully offset the programme costs.

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