Intermediate care for older people in the UK
Editor – I welcome Woodford and George's recent journal article (Clin Med April 2010 pp 119–23). Older people represent the fastest growing sector of the population in the UK. Health and social care design is of paramount importance not simply because of the burgeoning cost, but because how we treat the frailest and most vulnerable in society is the barometer of developed countries whose human cost can be measured in disability, morbidity and death.
Woodford and George's article highlights that ‘failing to plan is planning to fail’ as the wholesale national investment in healthcare policy without an adequate evidence base is resource put at risk. The clear message is that healthcare systems that are centrally managed and funded must show greater governance and invest in research and evidence development before implementing healthcare policy.
Nevertheless the message may not be as gloomy in relation to cost savings as indicated by the authors. Firstly because the evidence for community rehabilitation as reviewed in a meta-analysis of 96 trials of 97, 984 people by Beswick and colleagues is strong in terms of reduced nursing home admissions (odds ratio (OR) 0.87, 0.83–0.90), hospital admissions (OR 0.94, 0.91–0.97) and falls (OR 0.90, 0.86–0.95).1 In addition, there was clear benefit from improved physical function. Secondly because even modest benefits in the reduction of admission to nursing homes (as cited in the paper) is both an outcome desirable to patients and because the cost saving to society is significant. In the current economic climate the NHS cannot operate in isolation to other publicly funded local authority partners where closer cooperation may benefit both in cost avoidance and must be considered unavoidable.
Robust evaluation, transparent accountability and good metrics have got to go hand in hand with any development however, so that we do not risk further follies. And please, someone, invest in further research.
Footnotes
Please submit letters for the editor's consideration within three weeks of receipt of the Journal. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine{at}rcplondon.ac.uk
- Royal College of Physicians
Article Tools
Citation Manager Formats
Jump to section
Related Articles
- No related articles found.
Cited By...
- No citing articles found.