Readers' Letters − 5 April 2013

Home truths needed

David Oliver’s point about the lack of convincing evidence for the impact of prevention in your article, ‘Ex-older people’s tsar criticises out of hospitals obsession’(11 March 2013), is very prescient.

The new commissioning paradigm will need dependable evidence to underpin any investment in community interventions that work to reduce hospital admissions. Home improvement agencies are one community-based cohort working hard to improve how they articulate the economic value of their services, as well as the human benefits. These not-for-profit organisations adapt older people’s properties so they can live independently for longer and strong data is beginning to emerge about their impact.

London School of Economics’ research on investment in adaptations present compelling benefits. Researchers concluded that adaptations could reduce demand for health and social care by £1,079 per recipient per year (on top of quality of life gains of around £1,500 per annum − using Department of Health criteria). All this for an average yearly investment of £1,000.

Another project at St Helens and Knowsley Teaching Hospital in Whiston, involving the home improvement agency, social workers and occupational therapists, reduced the number of people who are medically fit yet occupying acute beds from 40 a week to an average of five a week, proving the high capital value of an integrated approach.

If we are going to win over colleagues such as Professor Oliver then we must strive for the causal links to confirm what we know instinctively to be the case. This is vital if we are going to be better placed to meet the growing demands an ageing population will surely put on acute services.

Andy Chaplin, director of Foundations, the national body for home improvement agencies and handyperson services

Emergency help for 111

The British Medical Association is quite right to urge the government to delay the national rollout of NHS 111 (‘BMA calls for 111 introduction delay’, 28 March 2013). As experts in emergency dispatch, we have repeatedly questioned the hasty implementation of this new service without any apparent consideration for proper testing and consultation.

The analysis of the pilot schemes should have sounded alarm bells when it became evident that NHS 111 was creating undue pressure on other health
services. Excessive call waiting times, rises in A&E attendance and increased pressure on ambulances − the very things the service was designed to alleviate − have all been widely reported.

The concept of NHS 111 is not a bad one, but the rush to implement the service has caused poor decisions to be made. Immediate action is needed to address the growing number of problems created by the service. If these problems continue to be ignored I fear this service could become a risk to patient safety.

Ron McDaniel, senior vice president at Priority Dispatch, an ambulance dispatch software provider