Caring for people with long-term conditions – for example, heart disease, asthma and diabetes – is a major element of the NHS’s work. There are 15.4 million people in England with at least one long-term condition, and it is thought many more are not yet diagnosed. 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. Patients with long-term conditions use a significant proportion of all appointments with GPs and outpatient clinics and of inpatient hospital bed days.
As well as the impact on individuals and their families, the burden on the economy is huge. The UK economy stands to lose £16 billion over the next 10 years through premature deaths due to heart disease, stroke and diabetes.
Current policy on long-term conditions seeks to reduce this burden through prevention and developing services that enable people to remain living independently in their own homes. It also seeks to empower patients, give them information about their condition and offer them choice about where and how they are treated.
This will require a radical rethink in how services are delivered. Health professionals in primary and secondary care will have to work together much more closely, as well as with those in the social care and voluntary sectors. GPs have been given incentives to do this through the quality and outcomes framework of the GP contract, while PCTs are being encouraged through the world-class commissioning framework.
The Department of Health has initiated a wide range of projects to support the development of new services. They have, for example, provided commissioners of health and social care services with information and support to provide personalised care plans for people with long-term conditions, helping them to manage their conditions better and achieve the outcomes they want for themselves. The law is currently being changed to allow people with a long-term condition to receive a personal health budget that they can spend on their own health care. The Department is also piloting information prescriptions, which provide people with sources of information about their health and care – for example, about their condition, available treatments or support groups.
Other work is looking at whether health professionals such as GPs can identify patients most at risk of a hospital admission and then intervene to manage them in the community – through, for example, the use of computer software tools. A large-scale randomised control trial of the role of telecare and telehealth in supporting people with long-term conditions at home is also under way.
