Skip to main content

Association between the 2012 Health and Social Care Act and specialist visits and hospitalisations in England: A controlled interrupted time series analysis.

Publication ,  Journal Article
Lopez Bernal, JA; Lu, CY; Gasparrini, A; Cummins, S; Wharam, JF; Soumerai, SB
Published in: PLoS Med
November 2017

BACKGROUND: 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. METHODS AND FINDINGS: 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. CONCLUSIONS: 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.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

PLoS Med

DOI

EISSN

1549-1676

Publication Date

November 2017

Volume

14

Issue

11

Start / End Page

e1002427

Location

United States

Related Subject Headings

  • Young Adult
  • United Kingdom
  • State Medicine
  • Middle Aged
  • Medicine
  • Male
  • Interrupted Time Series Analysis
  • Infant, Newborn
  • Infant
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Lopez Bernal, J. A., Lu, C. Y., Gasparrini, A., Cummins, S., Wharam, J. F., & Soumerai, S. B. (2017). Association between the 2012 Health and Social Care Act and specialist visits and hospitalisations in England: A controlled interrupted time series analysis. PLoS Med, 14(11), e1002427. https://doi.org/10.1371/journal.pmed.1002427
Lopez Bernal, James A., Christine Y. Lu, Antonio Gasparrini, Steven Cummins, J Frank Wharam, and 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 Med 14, no. 11 (November 2017): e1002427. https://doi.org/10.1371/journal.pmed.1002427.
Lopez Bernal JA, Lu CY, Gasparrini A, Cummins S, Wharam JF, Soumerai SB. Association between the 2012 Health and Social Care Act and specialist visits and hospitalisations in England: A controlled interrupted time series analysis. PLoS Med. 2017 Nov;14(11):e1002427.
Lopez Bernal, James A., et al. “Association between the 2012 Health and Social Care Act and specialist visits and hospitalisations in England: A controlled interrupted time series analysis.PLoS Med, vol. 14, no. 11, Nov. 2017, p. e1002427. Pubmed, doi:10.1371/journal.pmed.1002427.
Lopez Bernal JA, Lu CY, Gasparrini A, Cummins S, Wharam JF, Soumerai SB. Association between the 2012 Health and Social Care Act and specialist visits and hospitalisations in England: A controlled interrupted time series analysis. PLoS Med. 2017 Nov;14(11):e1002427.

Published In

PLoS Med

DOI

EISSN

1549-1676

Publication Date

November 2017

Volume

14

Issue

11

Start / End Page

e1002427

Location

United States

Related Subject Headings

  • Young Adult
  • United Kingdom
  • State Medicine
  • Middle Aged
  • Medicine
  • Male
  • Interrupted Time Series Analysis
  • Infant, Newborn
  • Infant
  • Humans