Background
It's estimated that 15.4 million people in England, almost one in three of the population, suffer from a long-term condition – for example, diabetes, asthma and heart disease. Patients with long-term conditions are very intensive users of health care services.
The NHS had developed guidelines and targets for specific diseases – for example, in the 1999 White Paper Saving Lives: Our healthier nation. But it was not until 2005 that a generic model for managing long-term conditions was recognised in the publication of the National Service Framework (NSF) for Long-Term Conditions.
This new framework acknowledged that while the diseases may differ, people with long-term conditions all need ongoing health care that changes as their illness progresses.
It set out how people should be supported to live independently and should have their care planned around their needs and choices, how they should have timely access to services and how all the agencies involved in their care, from health and social care through to the voluntary sector, need to work together to deliver this.
The driving force for this framework – and the subsequent refining of the policy around long-term conditions – was the recognition that without a radical rethink, long-term conditions would place an unmanageable burden on the NHS. Three out of every five people aged over 60 in England suffer from a long-term condition, and as the population ages, this proportion is likely to rise. People with long-term conditions are also very intensive users of services; they make up 31 per cent of the population but account for 52 per cent of GP appointments and 65 per cent of outpatient appointments.
In 2004, the previous government published the NHS Improvement Plan, which promised higher-quality care for people with long-term conditions. It pledged to roll out the Expert Patients Programme (in which patients receive intensive education to become experts in their own condition) throughout the NHS.
The 2006 White Paper Our Health, Our Care, Our Say went further in recognising and trying to address the key issues for people with long-term conditions and looking at services that could be delivered safely and effectively in the community or at home and that could be integrated and tailored to individuals’ needs. Following recommendations made in the NHS Next Stage Review, the Health Act of 2009 provided for pilots of personal health budgets to give people greater control over the services they use and who provides them. At the same time, research projects to test the use of telecare and telehealth in supporting independent living have been developed alongside, new specialist nursing roles, and sophisticated computer tools that allow health care professionals to identify and support people at risk.
