Association between the 2012 Health and Social Care Act and specialist visits and hospitalisations in England: A controlled interrupted time series analysis.
<h4>Background</h4>The 2012 Health and Social Care Act (HSCA) in England led to among the largest healthcare reforms in the history of the National Health Service (NHS). It gave control of £67 billion of the NHS budget for secondary care to general practitioner (GP) led Clinical Commissi...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2017-11-01
|
| Series: | PLoS Medicine |
| Online Access: | https://doi.org/10.1371/journal.pmed.1002427 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849521461260189696 |
|---|---|
| author | James A Lopez Bernal Christine Y Lu Antonio Gasparrini Steven Cummins J Frank Wharam Steven B Soumerai |
| author_facet | James A Lopez Bernal Christine Y Lu Antonio Gasparrini Steven Cummins J Frank Wharam Steven B Soumerai |
| author_sort | James A Lopez Bernal |
| collection | DOAJ |
| description | <h4>Background</h4>The 2012 Health and Social Care Act (HSCA) in England led to among the largest healthcare reforms in the history of the National Health Service (NHS). It gave control of £67 billion of the NHS budget for secondary care to general practitioner (GP) led Clinical Commissioning Groups (CCGs). An expected outcome was that patient care would shift away from expensive hospital and specialist settings, towards less expensive community-based models. However, there is little evidence for the effectiveness of this approach. In this study, we aimed to assess the association between the NHS reforms and hospital admissions and outpatient specialist visits.<h4>Methods and findings</h4>We conducted a controlled interrupted time series analysis to examine rates of outpatient specialist visits and inpatient hospitalisations before and after the implementation of the HSCA. We used national routine hospital administrative data (Hospital Episode Statistics) on all NHS outpatient specialist visits and inpatient hospital admissions in England between 2007 and 2015 (with a mean of 26.8 million new outpatient visits and 14.9 million inpatient admissions per year). As a control series, we used equivalent data on hospital attendances in Scotland. Primary outcomes were: total, elective, and emergency hospitalisations, and total and GP-referred specialist visits. Both countries had stable trends in all outcomes at baseline. In England, after the policy, there was a 1.1% (95% CI 0.7%-1.5%; p < 0.001) increase in total specialist visits per quarter and a 1.6% increase in GP-referred specialist visits (95% CI 1.2%-2.0%; p < 0.001) per quarter, equivalent to 12.7% (647,000 over the 5,105,000 expected) and 19.1% (507,000 over the 2,658,000 expected) more visits per quarter by the end of 2015, respectively. In Scotland, there was no change in specialist visits. Neither country experienced a change in trends in hospitalisations: change in slope for total, elective, and emergency hospitalisations were -0.2% (95% CI -0.6%-0.2%; p = 0.257), -0.2% (95% CI -0.6%-0.1%; p = 0.235), and 0.0% (95% CI -0.5%-0.4%; p = 0.866) per quarter in England. We are unable to exclude confounding due to other events occurring around the time of the policy. However, we limited the likelihood of such confounding by including relevant control series, in which no changes were seen.<h4>Conclusions</h4>Our findings suggest that giving control of healthcare budgets to GP-led CCGs was not associated with a reduction in overall hospitalisations and was associated with an increase in specialist visits. |
| format | Article |
| id | doaj-art-fd9d48823a8a44889f423bf277a1d290 |
| institution | Kabale University |
| issn | 1549-1277 1549-1676 |
| language | English |
| publishDate | 2017-11-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Medicine |
| spelling | doaj-art-fd9d48823a8a44889f423bf277a1d2902025-08-20T03:25:46ZengPublic Library of Science (PLoS)PLoS Medicine1549-12771549-16762017-11-011411e100242710.1371/journal.pmed.1002427Association between the 2012 Health and Social Care Act and specialist visits and hospitalisations in England: A controlled interrupted time series analysis.James A Lopez BernalChristine Y LuAntonio GasparriniSteven CumminsJ Frank WharamSteven B Soumerai<h4>Background</h4>The 2012 Health and Social Care Act (HSCA) in England led to among the largest healthcare reforms in the history of the National Health Service (NHS). It gave control of £67 billion of the NHS budget for secondary care to general practitioner (GP) led Clinical Commissioning Groups (CCGs). An expected outcome was that patient care would shift away from expensive hospital and specialist settings, towards less expensive community-based models. However, there is little evidence for the effectiveness of this approach. In this study, we aimed to assess the association between the NHS reforms and hospital admissions and outpatient specialist visits.<h4>Methods and findings</h4>We conducted a controlled interrupted time series analysis to examine rates of outpatient specialist visits and inpatient hospitalisations before and after the implementation of the HSCA. We used national routine hospital administrative data (Hospital Episode Statistics) on all NHS outpatient specialist visits and inpatient hospital admissions in England between 2007 and 2015 (with a mean of 26.8 million new outpatient visits and 14.9 million inpatient admissions per year). As a control series, we used equivalent data on hospital attendances in Scotland. Primary outcomes were: total, elective, and emergency hospitalisations, and total and GP-referred specialist visits. Both countries had stable trends in all outcomes at baseline. In England, after the policy, there was a 1.1% (95% CI 0.7%-1.5%; p < 0.001) increase in total specialist visits per quarter and a 1.6% increase in GP-referred specialist visits (95% CI 1.2%-2.0%; p < 0.001) per quarter, equivalent to 12.7% (647,000 over the 5,105,000 expected) and 19.1% (507,000 over the 2,658,000 expected) more visits per quarter by the end of 2015, respectively. In Scotland, there was no change in specialist visits. Neither country experienced a change in trends in hospitalisations: change in slope for total, elective, and emergency hospitalisations were -0.2% (95% CI -0.6%-0.2%; p = 0.257), -0.2% (95% CI -0.6%-0.1%; p = 0.235), and 0.0% (95% CI -0.5%-0.4%; p = 0.866) per quarter in England. We are unable to exclude confounding due to other events occurring around the time of the policy. However, we limited the likelihood of such confounding by including relevant control series, in which no changes were seen.<h4>Conclusions</h4>Our findings suggest that giving control of healthcare budgets to GP-led CCGs was not associated with a reduction in overall hospitalisations and was associated with an increase in specialist visits.https://doi.org/10.1371/journal.pmed.1002427 |
| spellingShingle | James A Lopez Bernal Christine Y Lu Antonio Gasparrini Steven Cummins J Frank Wharam Steven B Soumerai Association between the 2012 Health and Social Care Act and specialist visits and hospitalisations in England: A controlled interrupted time series analysis. PLoS Medicine |
| title | Association between the 2012 Health and Social Care Act and specialist visits and hospitalisations in England: A controlled interrupted time series analysis. |
| title_full | Association between the 2012 Health and Social Care Act and specialist visits and hospitalisations in England: A controlled interrupted time series analysis. |
| title_fullStr | Association between the 2012 Health and Social Care Act and specialist visits and hospitalisations in England: A controlled interrupted time series analysis. |
| title_full_unstemmed | Association between the 2012 Health and Social Care Act and specialist visits and hospitalisations in England: A controlled interrupted time series analysis. |
| title_short | Association between the 2012 Health and Social Care Act and specialist visits and hospitalisations in England: A controlled interrupted time series analysis. |
| title_sort | association between the 2012 health and social care act and specialist visits and hospitalisations in england a controlled interrupted time series analysis |
| url | https://doi.org/10.1371/journal.pmed.1002427 |
| work_keys_str_mv | AT jamesalopezbernal associationbetweenthe2012healthandsocialcareactandspecialistvisitsandhospitalisationsinenglandacontrolledinterruptedtimeseriesanalysis AT christineylu associationbetweenthe2012healthandsocialcareactandspecialistvisitsandhospitalisationsinenglandacontrolledinterruptedtimeseriesanalysis AT antoniogasparrini associationbetweenthe2012healthandsocialcareactandspecialistvisitsandhospitalisationsinenglandacontrolledinterruptedtimeseriesanalysis AT stevencummins associationbetweenthe2012healthandsocialcareactandspecialistvisitsandhospitalisationsinenglandacontrolledinterruptedtimeseriesanalysis AT jfrankwharam associationbetweenthe2012healthandsocialcareactandspecialistvisitsandhospitalisationsinenglandacontrolledinterruptedtimeseriesanalysis AT stevenbsoumerai associationbetweenthe2012healthandsocialcareactandspecialistvisitsandhospitalisationsinenglandacontrolledinterruptedtimeseriesanalysis |