Preventing hospital admission: we need real evidence

摘要

In July 2014 commissioners throughout England published projections for reductions in urgent admissions to their local hospitals. But the size and speed of these reductions were not informed by any credible peer reviewed evidence-they rarely are. Recent reviews by the Universities of Cardiff and Bristol on admission prevention, and by the health think tank the Nufheld Trust on new models of service in the community, found that the big and rapid reductions were illusory, once the findings had been peer reviewed and control data taken into account. Similar annual projections have been made for at least a decade. Yet although we have lost about one third of acute and emergency hospital beds in England in the past 25 years, emergency admissions have risen by 37% in the past decade. This farcical game represents a triumph of management consultancy over evidence, and of hope over experience. Local plans are based on how much money commissioners need to "save" on acute activity rather than any realistic expectation of service delivery. Savings are rarely made just by shifting the setting of care even if community alternatives to hospital are available, effective, and cheaper.