NHS patients told to treat themselves

Millions of people with arthritis, asthma and even heart failure will be urged to treat themselves as part of a Government plan to save billions of pounds from the NHS budget. Instead of going to hospital or consulting a doctor, patients will be encouraged to carry out "self care" as the Department of Health (DoH) tries to meet Treasury targets to curb spending. The guidelines could mean people with chronic conditions:

* Monitoring their own heart activity, blood pressure and lung capacity using equipment installed in the home

* Reporting medical information to doctors remotely by telephone or computer

* Administering their own drugs and other treatment to "manage pain" and assessing the significance of changes in their condition

* Using relaxation techniques to relieve stress and avoid "panic" visits to emergency wards.

Gordon Brown hinted at the new policy in a message to NHS staff yesterday, promising a service that "gives all of those with long-term or chronic conditions the choice of greater support, information and advice, allowing them to play a far more active role in managing their own condition". The Prime Minister claimed the self-care agenda was about increasing patient choice and "personalised" services. But an internal Government document seen by The Daily Telegraph makes clear that the policy is a money-saving measure, a key plank of DoH plans to cut costs.

Critics claimed the plan would provide doctors with an excuse for ignoring the elderly or those with debilitating, but not life-threatening long-term conditions, and would not work without significant investment in community health services. The Arthritis Research Campaign said it risked providing health managers with "an excuse for neglecting elderly patients". Jane Tadman, a spokesman for the charity, said: "Arthritis is already too low down the priority list and the fact that this is being mooted as a money-saving measure is very worrying. "Some GPs don't take arthritis seriously enough, and the result of this could be to give them another excuse to tell arthritis patients just to go away and take their tablets."

The Patients' Association welcomed more moves to empower patients, but warned against using self-care systems to save money. "We are all for better-informed patients," said Katherine Murphy, a spokesman. "But it is a concern that financial pressures will take precedence over clinical needs."

Peter Weissberg, the medical director of the British Heart Foundation, said: "People affected by heart disease need specialist care. Whilst we support changes that empower people to look after their own health, we would be very concerned if they led to any reduction in the availability or quality of expert care for those who need it."

After years of record spending, the health service is facing a sharp slow-down as Mr Brown tries to curb soaring government borrowing. In the Comprehensive Spending Review last year, it was announced that the health budget will grow by four per cent a year over the next three years, down from the seven per cent annual growth rate between 2002 and 2007.

The Treasury also demanded that the DoH achieves three per cent "efficiency savings" over the next three years, equivalent to o8.2 billion. The department's "Value for Money Delivery Agreement" - an internal document drawn up with the Treasury and circulated to NHS trusts over the Christmas holiday - sets out how the NHS will meet the savings target. In a section on chronic conditions, it says the key to greater efficiency in the management of patients with long-term illnesses is a reduction in the need for "expensive" interventions by the NHS. "Reductions in the use of NHS (GP consultations, outpatient appointments, inpatient admissions, length of stay, emergency care and prescribing) can be achieved through increased support for self care (for example through education and skills training, information prescriptions, or self care devices)," it says.

The DoH has told the Treasury that NHS officials are drawing up "good practice guidance on care planning including support for self care". The advice is expected to be published next month. The emphasis on self care was inspired by the success of the Expert Patients Programme, an NHS pilot scheme that offers a six-week training course for people with chronic or long-term conditions. About 30,000 people have completed the course and reduced their hospital attendances by up to 16 per cent, a result NHS managers hope to repeat across the service.

Health budgets face pressure from the cost of caring for people with chronic conditions, including 8.5 million with arthritis, 3.4 million with asthma, 1.5 million diabetics and 500,000 with heart failure. Opposition politicians questioned whether the Government could save money without reducing services. But an Asthma UK spokesman said: "Our focus is on the clinical benefits of self-management. "If the Government implements procedures to ensure more self management and save money, we would support that."

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Australia: Another deadly government hospital

One of the main reasons for putting people in these hospitals is to keep them safe -- from themselves and others!

A 22-year-old woman has been found dead in her room at the controversial mental health facility Ward 1E at the Launceston General Hospital. The death came just a day after an independent reviewer commented that the ward was overcoming a "very negative" culture which included bullying and harassment.

Director of Mental Health Services Associate Professor Des Graham said attempts by staff to resuscitate the woman on Wednesday night were unsuccessful. "The death of a client in an acute mental health facility is a rare and tragic occurrence and in line with Mental Health protocols it will be investigated," he said. Health Minister Lara Giddings said the case would be investigated and action taken if shortcomings in the treatment were found.

The woman's family was notified and met with senior staff. Her body was found about 7.20pm. Detective-Inspector Mike Otley said there were no suspicious circumstances. The woman from Launceston is believed to have been in the facility for a couple of days.

Prof Graham said an interstate team would be called in to head a serious incident investigation. "It is normal practice with serious incidents of this nature for a panel to be established to review the treatment and care provided," he said. The investigation would be in addition to an inquiry by a coroner. Investigations would include an analysis of whether the skill mix and number of staff was adequate and what the documentation about the client's mental state said. Prof Graham said family, staff and other patients on the ward have been offered counselling.

The recently concluded Santangelo inquiry also found that allegations of sexual assault were sometimes ignored because of perceptions about the mental state of complainants. An investigation by the Health Complaints Commission released in 2005 found three cases of sexual assault. Ms Giddings said the death was tragic and distressing. "I extend my sincere condolences to her family," she said.

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