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Background

David Colin-Thome, National Clinical Director for Primary Care

Over fifteen million people in this country report living with a long term condition. Long term conditions are those conditions that cannot, at present, be cured, but can be controlled by medication and other therapies. They include diabetes, asthma, and chronic obstructive pulmonary disease. Of these, many live with a condition that limits their ability to cope with day-to-day activities.

For some people, especially older people and those who have more than one condition, discomfort and stress is an everyday reality. For those living in disadvantaged circumstances or for whom English is not their first language, the challenges are even greater. And for the most vulnerable, a lack of co-ordinated, personalised care can lead to a significant deterioration in health and often avoidable emergency admissions.

It is important to recognise that health and social care teams across the country are routinely offering quality care to these patients. Examples of local excellence are not hard to find, including care provided by general practice to its registered population, progress in implementing the National Service Frameworks and support from social care. But now, as with the global health community, the NHS and its partners in social care and the voluntary sector face a crucial junction as the incidence of long term conditions is set to increase.

This is why the NHS Improvement Plan, published in June 2004, set out the government's priority to improve care for people with long term conditions by moving away from reactive care based in acute systems, towards a systematic, patient-centred approach. Care needs to be rooted in primary care settings and underpinned by vastly improved communication and new partnerships across the whole health and social care spectrum. 'The NHS Improvement Plan' identified long term conditions as one of the three top priorities for the NHS in the period up to 2008.

Long term conditions have become a priority because of the changing burden of disease and the increasing prevalence of conditions such as diabetes, asthma, arthritis and heart disease. People with long term conditions are more likely to see their GP, be admitted to hospital, and stay in hospital longer than people without long term conditions. They are also increasingly involved in managing their conditions with the support of the health care team.

We want to provide patients the most intensive care in the least intensive setting. To do this we need to move away from a reactive, unplanned and episodic approach to care, particularly for those with complex conditions and high intensity needs. For example, eight of the top eleven causes of hospital admissions are long term conditions. The services are there to help them when their condition reaches crisis point, but often fail to provide the on-going, co-ordinated support needed to prevent such crises from happening in the first place.

Supporting people with long term conditions

• The Governments aim is to promote and spread across the NHS approaches that will lead to improved services and support for people with long term health and social care needs – the specific aims being to produce better health outcomes and quality of life, slow disease progression and reduce disability.  This in turn will result in improved quality of life, helping to relieve discomfort and stress and reduce the need for hospital admission.

• People with long term conditions have better lives when they are supported to take care for their conditions themselves.  If people have a clear understanding of their condition and what they can do, they are more likely to take control themselves.  One of the priorities from participants in the ‘Your health, your care, your say’ consultation was for services based around their needs which help them take control of their health, support their well-being; and enable them to lead an independent and fulfilling life.

• Our health, our care, our say: a new direction for community services (January 2006) sets out a vision and package of proposals designed to address the expectations and outcomes that people want for themselves; maintaining a sense of well-being; and leading an independent life.  There is solid evidence that care is less effective if people feel they are not in control. 

• Three themes run throughout the White Paper:

• enabling and supporting health, independence and well being;
• rapid and conventional access to high quality, cost effective care; and
• putting people more in control of their own health.

• Self care lies at the heart of putting people in control and plays a key role in improving the management of long term conditions. Self care is “led, owned and done by people themselves.  NHS and social care organisations cannot do self care to people, but what they can do is create the right environment where people feel supported to self care.”  This definition is taken from the self care guide for supporting people with long term conditions that we published shortly after the White Paper.

• The self care guide for supporting people with long term conditions – ‘Supporting people with long term conditions to Self Care – A guide to developing local strategies and good practice’ (published 24th February 2006) complements the proposals set out in the White Paper and both reinforce our existing programme of reform.

• The document sets out the context for why the NHS in particular, needs to embrace the philosophy of self care and advocate it, in order to support patients with long term conditions to adopt self care behaviours.  The document identifies four key areas in which patients need support (skills & training, information, tools & devices and support networks) and gives examples of good practice together with the role of patients, professionals and PCTs/Trusts in supporting these areas.  The aim of the document is to help NHS organisations develop local self care strategies.