Monday, January 30, 2006

Brits acknowledge the limits of State control of medical services

They're so desperate they are clutching at any hope

Ministers are hoping to rescue the NHS from its continuing cash problems through a "semi-privatised" scheme that trains patients to avoid hospital or their GP. The Expert Patient Programme, which has cut hospital visits by 16 per cent in trial areas, is to have its budget tripled before becoming a not-for-profit company, The Times understands.

Details of the "flotation" will be carried in a make-or-break White Paper on patient care outside hospital to be published this month.

Patricia Hewitt, the Health Secretary, wants the White Paper to spell out how the NHS will reduce demand for the most expensive form of treatment - in hospitals. Training patients how to "self-care" will be at the core of the proposals. Although the cost savings for hospitals and GPs would be several years down the line, the change in emphasis to self-care is one reason why some of the biggest hospital-building schemes in the NHS are now under review. Ms Hewitt believes that the best way to expand the Expert Patient Programme rapidly is by allowing NHS managers or outside providers to take it over from state control. She is expected to pave the way by increasing the budget from 6 million pounds a year to 18 million pounds.

The programme works by running training courses for patients with chronic conditions such as diabetes, asthma, multiple sclerosis and arthritis. They learn how to treat themselves when previously they would have gone to their doctor or the hospital accident and emergency department, and to avoid such emergencies altogether by looking after themselves better.

The programme, set up four years ago, was based on an American "self-care" plan devised to save on the astronomical costs of US hospital care and was tested in various areas of Britain. Six months into the trials, GP consultations fell by 7 per cent, while local outpatient visits and emergency care attendances dropped by 10 per cent and 16 per cent respectively. Hospital admissions among those on the scheme were also reduced by 13 per cent. Patients said that they became better at controlling symptoms, more confident, and better at using information from books and support groups.

A senior NHS source said that, despite initial concerns from some GPs, ministers were impressed with the benefits to patients as well as potential cost savings. The source added: "The Expert Patient Programme is an excellent example of how the NHS is changing the way it works with people with long-term conditions. We want to build on this experience as part of expanding and developing self-care. "We want the EPP to help more of the 17 million people in England with long-term conditions so that more people understand and can do more to manage their own conditions."



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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