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
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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
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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
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
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
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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;
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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
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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
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www.hsmc.ac.uk - Strategic Framework for Dorset
and Somerset
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www.networks.nhs.uk
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www.expertpatients.nhs.uk
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www.kingsfund.org.uk

www.cmsa.org - Case Management Society of
America
2 September 2005