By Claire West

The NHS can’t afford to stand still if it is going to cope with the increasing number of people with two or more long term conditions — set to increase dramatically by 252 per cent by 2050 — Health Secretary Andrew Lansley said today.

Almost one in three of the population have a long term condition - such as asthma, heart and lung disease, arthritis, hypertension and diabetes - and half of people over the age of 60 have one. They are the biggest users of the NHS accounting for around 50 percent of GP appointments and 70 per cent of inpatient hospital beds meaning 30 per cent of the population accounts for 70 per cent of the spend.

The NHS will not be able to meet this increase in demand unless it changes. Add to that the fragmented and inefficient way the NHS currently looks after people with long term conditions and the health service just won’t be able to cope a few years from now.

The 15 million people with long term conditions want a different approach — they do not want to spend time in hospital and they want more say in the care they get and the way it is delivered. They will all benefit from a modernised NHS by being treated more effectively and intelligently.

The new, modernised NHS will improve the lives of people with long term conditions by:

Giving them more support to self care — for example providing asthmatics with new technology they can use at home to check their lung function so they can pick up problems quickly before they get so bad they have to go to hospital. Or empowering people to self manage their own clotting therapy — a Cochrane study found a 50 per cent reduction in the number off blood clots and a reduction in deaths.

Remaining independent for longer using new technology — for example telehealth and telecare technology means people can have their vital signs monitored remotely by a health professional and any problems can be picked up before they get serious and need hospital treatment — in one case this has reduced the number of days spent in hospital in one year from more than 300 to around ten.

Simplifying who cares most for a person — one professional not five.

Healthcare professionals focussing on the overall health and wellbeing of the patient rather than just managing one of their conditions.

Patients throughout the country are already benefitting from this:

In Ipswich a pilot project which has helped 107 patients to better manage their own conditions has seen a 75 per cent reduction in GP visits and a 75 per cent reduction in bed days in hospital over a six month period. Staff are also being trained to become health coaches to their patients.
Sutton Council has installed monitoring devices in patients’ homes so GPs can monitor their clients’ blood pressure, blood oxygenation and other indicators so they can take early action. A six month pilot in the borough reduced admissions and saved around £322,000.

In Swindon a Community Matron oversees patients with long term conditions. The Matron ensures people are educated about their condition and are more in control and confident to cope when they feel unwell. Using telehealth patients monitor their own blood pressure, weight and pulse knowing that there is someone at the end of the phone if their vital signs are not as they should be.

GPs in Barking and Dagenham are pinpointing high risk patients and giving them a care coordinator to prevent several people going to visit a patient.

Andrew Lansley said:

“An increasing number of people are living with long term illness, and increasingly two or more serious illnesses. The average cost of someone without a long term condition is around £1,000 per year, which rises to £3,000 for someone with one condition and to £8,000 for people with three or more conditions, the additional associated cost pressure of caring for people with multiple co-morbidities could reach £4 billion by 2016.

“That’s one reason why we need to modernise the health service and the way we care for patients.

“There isn’t a one size fits all solution to our health — particularly for those who have a number of different conditions. The modernised NHS will see local health experts in charge of commissioning services. They will have the power and the budget to put the overall health of their patient first — rather than having to pigeon-hole people by individual illnesses.

“Patients don’t want to see lots of different people for lots of different consultations — they want one team who can give them the advice, support and care they need. The NHS in the future will give patients better and more efficient care, keeping people well and out of hospital.”

There is currently a very fragmented system in the NHS. Patients who live with asthma and heart disease, for example, too often have to see separate specialists who will see their condition in isolation.

A more streamlined, efficient NHS will see a patient having one contact — an expert who will get other specialist advice when they need it — but who will be the one expert assigned to a particular patient, taking account of all their needs.

Sir John Oldham, National Clinical Lead for Quality and Productivity for the NHS said:

“By 2050, the number of over 65s with two or more long term conditions will have risen by 252 per cent. This means that if we continue to manage people with long term conditions as we do now, the NHS is not sustainable.

“We have unwittingly created a more fragmented system. Too often it may seem that a line of case managers is queuing up outside a single person’s house, each one dealing with a different illness. This is sub optimal care for the patient and palpably inefficient for the NHS.

“Patients want us to care for the whole of them and act as one team. That’s why we are now actively making changes all across the country with doctors, nurses, social carers and patients improving outcomes, improving care and being more efficient.”

Better outcomes, more efficient and improved involvement. That is what the changes are about. Transformational change that engages people in decisions about their care in a way that helps them be in control of their conditions not the other way around. Providing options for how to interact with the NHS so that it becomes more convenient and relevant to peoples’ modern lives.

All of this is possible. Using the technology at the health service’s disposal to help people stay independent for longer, receive care online or in their own homes, avoid unplanned hospital admissions or unnecessary visits to clinics. Offering different ways to communicate with health professionals means a more streamlined efficient NHS.