National health programs

Teenage carers met nurses, doctors, political and NHS leaders at London Zoo to highlight the health and social care needs of an estimated 166,000 young carers in England.

The increase of chronic illness as a leading cause of death has given rise to self-care and expert patient initiatives. Caring for chronically ill people places a tremendous economic burden on the health care system, informal carers, the labour market and benefit system (Department of Health 2001, 2004, 2005). Thus, in many countries health policy encourages patients to become ‘experts’ in the self-management of their conditions in the belief that it will help save money and improve health and well-being (Wanless 2002).

Objectives: To test the hypotheses that older people and their informal carers are not disadvantaged by home-based rehabilitation (HBR) relative to day hospital rehabilitation (DHR) and that HBR is less costly.

Design: Two-arm randomised controlled trial.

Setting: Four trusts in England providing both HBR and DHR.

Participants: Clinical staff reviewed consecutive referrals to identify subjects who were potentially suitable for randomisation according to the defined inclusion criteria.

Interventions: Patients were randomised to receive either HBR or DHR.

Ask the experts is a forum in which consultant nurses working with older people debate an issue in older people's care and offer advice. This month, Soline Jerram, consultant nurse: older people and intermediate care, from Windsor, Ascot and Maidenhead PCT, poses questions brought to her by intermediate care staff and informal carers.