Resources

Key resources to support delivery of the long term conditions programme:

  • LTC Dashboard: Clinical Commissioning Group (CCG) Outcomes tool and explorer is an interactive tool for commissioners and clinicians based on the 44 sustainability and transformation areas with the ability to drill into CCG and local authority areas to support intelligence-led decision-making.
  • Atlas of Variation which includes insights into how CCGs compare nationally and with areas that have a similar demographic.
  • Commissioning for Value packs providing practical support for clinical commissioning groups (CCGs) and local health economies, in gathering data, evidence and tools to help them improve the way care is delivered for their patients and populations,.
  • The Long Term Conditions Year of Care Commissioning Programme Implementation Handbook has been published. The handbook is the main output of the Year of Care Commissioning Programme. It describes the experiences of five care economies working as part of the programme as they work towards developing capitated budgets for some patients and services.
  • Learning Environment: supports CCGs and other organisations to access and share learning and good practice and provides open access to search a range of commissioning and other support services, including for long term conditions.
  • NICE draft clinical guideline on multi-morbidity: Assessment, prioritisation and management of care for people with commonly occurring multi-morbidities. Evidence based recommendations for people with multi-morbidity, a tailored approach to care and frailty.
  • A collaboration including SIMUL8, Datalytics, a small group of CCGs, and NHS England has developed a tool to help organisations understand the financial and/or activity implications for new models of care for people with long-term conditions across different cohorts of patients and settings.  The model can be accessed for free by registering at

Handbooks: practical support for clinicians and commissioners about how to implement good person centred long term condition care.  They include:

Key resources to support the older peoples programme:

  • Toolkit for General practice in supporting older people living with frailty offers a suite of tools to support case finding, assessment and case management of frail older people.
  • Practical Guide to Healthy Ageing supported self-management guide co-produced by NHS England and Age UK which covers the main risk factors to functional decline in people living at home.
  • Practical Guide to Healthy Caring: companion guide to the healthy ageing guide which provides information and advice to older carers about staying healthy whilst caring, and identifies the support available to help carers maintain their health and wellbeing.
  • Fire and Rescue Service as a health asset support – each year the fire and rescue service carry out around 670,000 visits to people’s homes in England. They are being broadened into ‘Safe and Well’ visits which address risk factors affecting fire and health, including cold homes and falls. Working with partners, NHS England have produced a number of documents to show how commissioners can work with their local fire and rescue service to better support older people and those with long term conditions.
  • British Geriatric Society’s ‘Fit for Frailty’: provides advice and guidance on the development, commissioning, and management of services for people living with frailty in community settings. It is aimed at GPs, geriatricians, health service managers, social service managers and commissioners of services.
  • LTC Dashboard: The Clinical Commissioning Group (CCG) outcomes tool and explorer showing a summary of metrics to support commissioning and benchmarking for long term conditions across five areas; risk factors, prevalence, quality of care, quality of life and economic activity which can present data by CCG, local authority, or Sustainability Transformation Plan footprints areas.
  • Our Declaration sets out the importance of person centred care for people with long term conditions, what needs to change and why we need to change. It was developed for and with input from health and care professionals, policy makers and people with long term conditions.
  • Atlas of Variation supported by the RightCare team includes insights into how your CCG compares nationally and with its peers.
  • House of Care provides a strategic framework for integrated care for people with long term conditions.
  • Personalised care and support planning – enabling commissioners and health care practitioners to deliver personalised care. The updated handbooks have been jointly developed with the Coalition for Collaborative Care.
  • Multi-disciplinary team (MDT) working – supporting health and care professionals to work across professional and organisational boundaries.
  • NICE draft clinical guideline on multi-morbidity: Assessment, prioritisation and management of care for people with commonly occurring multimorbidities. Evidence based recommendations for people with multimorbidity, a tailored approach to care and frailty.
  • Learning Environment: supports CCGs and other organisations to access and share learning and good practice and provides open access to search a range of commissioning and other support services including for long term conditions.

Key resources to support the fire as a health asset programme:

Fire as a health asset case studies

The CFOA website has an ever-expanding collection of resources relating to Fire as a Health Asset work. These include a number of case studies showcasing individual fire and rescue service’s (FRS’s) work and a document produced by CFOA which describes the impact that Safe and Well visits have had on eight individuals and the outcomes of their assessment.

The Local Government Association’s ‘Beyond Fighting Fires 1’ contains eight case studies on the work of fire and rescue services (FRSs) and partner agencies with people with dementia and other vulnerable people to reduce not just fire risk but other risks in the home. FRS staff are also being trained in promoting healthy living in a variety of ways including advice on diet and exercise.

Beyond Fighting Fires 2’ looks at transformation in the FRS and describes collaborative projects with clinical commissioning groups, police and ambulance services and an increasingly wide variety of other partners.

Here is just a taster of what some of those case studies contain:

  • West Midlands FRS targets interventions at vulnerable people with issues around frailty, mental health and terminal illness to tackle health inequalities.
  • All Gloucestershire FRS are dementia-trained and dementia nurses can refer for home fire safety checks. The service provides fire risk training to mental health teams.
  • Dementia friendly Kent FRS work to reduce fire risk in the home for people with dementia and identify early signs of dementia.
  • Wigan firefighters act as ‘health champions’ in their local community, working with over 20 partner agencies which can also make referrals to the FRS.
  • Cheshire FRS are using data analysis to pinpoint residents most at risk of fire and falls and in need of intervention.
  • Dorset’s Safe and Independent Living (SAIL) programme ensures vulnerable people receive assistance from the right agencies while ‘Days of Warmth’ aims to tackle the problem of cold homes and winter deaths in vulnerable local people.
  • Humberside firefighters have partnered with their CCG and Yorkshire Ambulance Service to provide first response to reports of falls in the home.

Key resources to support the musculoskeletal programme:

Key resources to support the neurology programme:

Key resources to support the paediatric asthma programme:

Key resources to support the end of life care programme: