Presentation to TCE 240904
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Transcript Presentation to TCE 240904
Services for People with Long Term
Conditions: Policy and Models of Care in
the United Kingdom
Jan Hull
Acting Director of
Development
Long Term Conditions
2
2 September 2005
the UK health system
NHS policy for long
term conditions
delivering improved
services: the proposed
model
emerging evidence on
the new approaches
local implementation.
The UK Health System
3
2 September 2005
Dorset and Somerset Strategic Health Authority
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Counties of Dorset and Somerset
Combined population of 1.2 million
Approximately 26,000 NHS employees
1,094 GPs in 178 Practices
25 Community Hospitals
NHS expenditure of approximately £1.25 billion
2 September 2005
Long Term Conditions
The WHO definition includes:
non- communicable conditions
persistent communicable conditions
long term mental disorders
ongoing physical/structural impairments
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2 September 2005
The Challenge
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Optimal management of chronic disease is one of
the most complex and potentially costly challenges
facing modern healthcare systems
78% of healthcare spending (US data)
WHO estimates 75% of global population living
with one condition, 50% with 2 or more
In the UK people with long term conditions use
60% of hospital bed days
2 September 2005
Increasing Policy Focus
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burden of ill health and disability
increasing prevalence of long term conditions and
related risk factors
high utilisation of services, particularly through
unplanned admissions, by people with multiple
conditions
learning from international models of care
2 September 2005
NHS Policy Context
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Transforming services for people with long term
conditions is now a central element of NHS policy
This commitment is set out in The NHS
Improvement Plan (2003) and the current 3 year
Planning Framework, ‘National Standards, Local
Action’
The model for delivering improved services
‘Supporting People with Long Term Conditions: An
NHS and Social Care Model to support local
innovation and integration’ was published in
January 2005
2 September 2005
Emergency Bed Day Targets
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national target of 5%
reduction in emergency
bed days by 2008 has
been set
for Dorset and
Somerset this equates
to 36,000 bed days
(baseline 858,000
emergency bed days in
2003/04)
2 September 2005
Shortfalls of the Current System
10
care tends to be reactive, episodic and hospital
based;
care often initiated by patient in crisis;
division between generalists and specialists;
routine primary care can be variable;
lack of coordination between services;
relatively little emphasis on prevention and self
care.
2 September 2005
Patients want:
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to be active participants in their own care;
a personalised service, tailored to their needs, and meeting
psychological as well as physical needs;
to receive services that are integrated across organisational
boundaries;
easy access to high quality information;
their care to be focused on improving quality of life.
2 September 2005
The NHS and Social Care Model
Key Strategies:
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integration of services
care that is proactive, structured and systematic,
matched to patient need
identification and targeting of people with complex
needs
provision of high quality information and education
promotion and support for self care
2 September 2005
The Pyramid Model of Care
Adapted from Kaiser Permanente
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2 September 2005
Level 3: Case Management
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identification of people at highest risk (case finding)
introduction of community matrons to provide high
level of personalised, proactive care
structured assessment and care planning
the community matron coordinates care across all
providers, and secures additional support where
necessary
2 September 2005
Level 2: Disease Management
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systematic disease management and care planning
this is a strength of the existing UK primary care
system, and has been enhanced by National Service
Frameworks and the new contract for General
Practitioners
proactive management of disease registers
expansion of interface services - diabetes, heart
failure, COPD, musculoskeletal
2 September 2005
Level 1: Self Care
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continued development of disease specific
education and rehabilitation;
expansion of the Expert Patient Programme;
mechanisms to ensure patients have appropriate
disease specific and generic education, information
and support;
awareness raising of the benefits and evidence for
self care among clinical staff.
2 September 2005
US Evidence
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Evercare model - 50% reduction in unplanned
admissions, reduction in medication, 97% family
and carer satisfaction rates
Veterans Administration - 50% reduction in bed day
rates from 1994 - 1998, 35% reduction in urgent
visit rates
Kaiser Permanente - significantly lower lengths of
stay
2 September 2005
Case Management
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International and national (UK) evidence confirms
this approach benefits patients
Kings Fund review concludes that evidence for
reducing emergency admissions is weak
no one model of case management has been shown
to be superior
in the UK 2 main models are being developed,
Evercare and Castlefields (Unique Care)
2 September 2005
Emerging Evidence - Evercare
One model of case management, piloted in 9 sites,
Interim Report published January 2005:
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high level of patient satisfaction
effective in identifying people whose needs
previously unmet
may reduce emergency admissions, but too early to
quantify this
strong results in some individual Primary Care
Trusts
2 September 2005
Emerging Evidence - Castlefields
Practice-led case management, now spreading
elsewhere
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15% reduction in admissions
average length of stay fell from 6.2 to 4.3 days
41% reduction in hospital bed days used by this
patient group
improved service coordination
2 September 2005
Expert Patient Programme
Pilot Evaluation shows:
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2 September 2005
7% reduction in GP
consultations
10% reduction in
outpatient visits
16% reduction in
Accident and
Emergency attendances
Local Implementation
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a Strategic Framework for Dorset and Somerset has
been developed, and implementation now underway
65 case managers will be in place by March 2007
Challenges for us are to shift service focus from the
hospital to the community, to maximise the
effectiveness of primary care and to effectively
embed self care
2 September 2005
Further Information
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www.dh.gov.uk - NHS and Social Care Model
www.hsmc.ac.uk - Strategic Framework for Dorset
and Somerset
www.networks.nhs.uk
www.expertpatients.nhs.uk
www.kingsfund.org.uk
www.cmsa.org - Case Management Society of
America
2 September 2005