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We are living longer – fact – Dr Martin McShane

Dr Martin McShane, NHS England’s Director for Long-Term Conditions, previews one of Innovation Expo’s central themes:

As the population lives longer the likelihood that many of us will end up with a long-term condition is also growing.  So it begs the question, how will the NHS deal with it and how much will it cost?

The treatment of long-term conditions is a central theme of this year’s Innovation Expo and the NHS faces tackling an issue which is the healthcare equivalent to climate change.

The statistics speak for themselves with more than a quarter of the population ­- 15.4 million people – is already dealing with the impact of a long-term condition, those that, at present, cannot be cured. And around 1.9 million people have three or more multiple conditions such as arthritis, mental health illness, heart disease, and diabetes. By 2018, the NHS is expecting that figure to increase significantly, to 2.9 million.

The challenge of meeting the increasing demands on NHS services as we look to the future requires radical thinking and radical change, at a pace that is unprecedented.

It requires a step-change in culture and practice that needs to be tackled in three parts. The first step is ‘risk-stratification’ to enable the NHS to understand the needs of the population and tailor services to meet those needs.

The second is care planning, focusing on the person rather than the disease and looking towards the best quality of life patients can enjoy and not just the best test results.

And thirdly, the need to work together as a team – uniting the expertise of GPs and hospitals with social support and third sector services. It’s a move that will allow care to be matched with the differing needs of patients and be more responsive in its dealings with them but also mobilises other assets, in the community, that help people have a better quality of life: “more than medicine”.

Most importantly, people want and need to be involved in planning their own care. They want to have support and care that gives them as much control as they want. They want to know who to turn to when they want help and be informed on where they can access support, and to have plans in place for the future – in case complications occur and to address foreseeable events, such as the potential for deterioration.

While there is much ground to cover, progress is being made:

Giving patients control – The NHS is equipping people with personal health budgets and is making the changes that allow wider and easier access to appointments, testing and results, allowing them to take control. Patients, carers, and families are being encouraged to become their own experts through programmes designed to give them the tools and confidence to manage conditions better on a daily basis.

Improved services – GPs are embracing new technology and training that allows them to better meet the needs of those with complicated health demands.  More are looking to add extra specialised services, whether it is access to treatment and nurses, diagnostics, or online support and electronic access to medical records for patients, and supporting people at home via telehealth.

Integrated care – The 14 pioneer areas which launched in November 2013 are leading the way in challenging the old ethos to show just how integrated care can pay dividends for all, giving faster access to services, cutting waiting times and reducing hospital admissions.

Mental health – Since April 2013, the NHS has been working on better integrating physical and mental health care to ensure patients receive the best service.

A wide programme of work is underway, overseen by a Parity of Esteem board, which will also inform and influence the Urgent and Emergency Care Review programme.

The NHS is one of the organisations to have signed up to the mental health crisis care concordat which outlines how police, mental health services, social work services and ambulance professionals should work together to help people going through a mental health crisis.

Integrated health care works, for the NHS and for patients. Across the country the NHS is rising to the challenge, from better dementia care to integrated team working for people with long-term conditions.

For those with long-term conditions, the NHS constitution carries particular resonance ­- “the NHS belongs to the people.” As the treatment model for long-term conditions evolves for the 21st century and beyond, it must increasingly have people at its heart.

The emergence of long term conditions as the biggest challenge facing the NHS cannot be underestimated. The changes required will be challenging for clinicians and for many others involved in living with and supporting people with long-term conditions.

It will take time, energy, resilience and focus to support the right change – yet, I believe, that the NHS has the greatest potential to meet the challenges and address them successfully.

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One comment

  1. Lynne Craven says:

    This is a start! However I would like to see patients as part of the team. Recently my GP suggested to me that it is her job to keep me alive and well for as long as possible… NO! It’s my job to take some responsibility for MY health. How do we hand over that responsibility to patients and start shifting the locus of control so it lies in the middle of the partnership between patient and doctor/nurse/consultant?

    See you at Expo 2014