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Nhs Case Management: Us Evercare Model

Volume 670: debated on Tuesday 1 March 2005

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2.53 p.m.

Whether they agree with the advice of the King's Fund that a further evaluation of the cost-effectiveness of the United States Evercare model for reducing emergency hospital admissions should be undertaken before this model is introduced in England and Wales.

No, my Lords, because we already have in progress an independent evaluation of the Evercare model by the National Primary Care Research and Development Centre. Its interim report provides evidence that care based on case management principles will improve the lives of those with more complex needs arising from long-term conditions. The NHS and social care model published on 5 January recommends that healthcare providers in England adopt those principles to improve the care and support offered to their local population. That model draws on experience from overseas, including Evercare, and the NHS, without advocating any particular scheme, and will be supported by the 3,000 new community matrons the Government are funding.

My Lords, I thank the Minister for his reply, but, having read the National Primary Care Research and Development Centre report on the Evercare model, it seems to me and many others who have reported on it that it is not the green light for which Ministers were hoping. Will the Government now invest in a much more robust evaluation further to what is being done at present in Manchester to consider different approaches to case management, beyond what Evercare is doing and, meanwhile, stop recruiting the 3,000 community matrons who they want to take that forward until the evidence is far clearer?

No, my Lords. As I tried to make clear, an interim evaluation is available. We will be receiving Manchester's final report in 2006. Sometimes, I think that there is no pleasing the Liberal Democrats. When we published the NHS and social care model on 5 January, we were chastised by the Liberal Democrat Front Bench for not moving fast enough. Now the Liberal Democrats seem to want us to go slower.

My Lords, does the Minister agree that case management is a tough and difficult job to do well, the complexity and difficulty of which is often underestimated, and that the successful overseas pilots in Australia and, extensively, in the United States have all required significant financial levers, bringing together specialist care, primary care and social services? When will the Government produce schemes within the NHS and social services here that mirror those successful schemes with financial incentives?

My Lords, we have done a number of things. We published the NHS and social care model for long-term conditions on 5 January. That distils the wisdom from a number of schemes, both overseas and here. There have been very good schemes in this country—those at Castlefields and Whipps Cross come to mind—of which I am sure that the noble Baroness is well aware. I accept that schemes need to be carefully planned and co-ordinated between health and social care, with GPs and with an enhanced nurses' role.

My Lords, the Minister mentioned community matrons. Can he reassure me that community matrons will have sufficient authority and resources at their disposal to make a real difference to how care is delivered outside the hospital setting?

My Lords, the noble Earl is quite right: they need to be properly trained and to have their role clearly defined. That was the purpose of publishing the model on 5 January. As the noble Earl will know, the Government have increased NHS resources by between 7 and 7.5 per cent for five years on the trot. Primary care trusts were given their three-year allocation a couple of weeks ago.

My Lords, have the Government evaluated the problems of rural areas, especially the out-of-hours problems of North Yorkshire? How will community matrons manage to get around the large mileage of the rural areas?

My Lords, under our shift of the balance of power and devolution of budgets it is of course down to primary care trusts to work out the details of schemes that are most appropriate to their areas. I will certainly look into out-of-hours provision in North Yorkshire and write to the noble Baroness.