Long term conditions in England

Although the management of long term conditions has been a key aspect of policy for some time, it is now a top priority in terms of improving quality and efficiency in the provision of services

Key aspects include:

• integration of service provision, including the use of integrated care pathways (since many people have more than one long term condition) and health and social services working together through a single contract
• maximising the ability of people to manage long term conditions since this improves clinical outcomes as well as the client’s experience

 
Major changes in health and social care policy are currently underway, following the introduction of the Health and Social Care Bill. Find out more about the Bill, as well as the White Paper, ‘Equity and Excellence: Liberating the NHS’. 
 

Outcomes

 
The focus on quality (where quality is defined as outcome, experience and safety) continues, but with a greater emphasis on outcomes. Three outcomes frameworks have been developed:

• The NHS Outcomes Framework
• The Adult Social Care Outcomes Framework
• The Public Health Outcomes Framework

 
Each framework contains up to five ‘domains’. Within these, a number of ‘over-arching indicators’ and ‘improvement areas’ are suggested which will be important for occupational therapists, for example:
NHS Outcomes Framework includes:

• ensuring people feel supported to manage their condition
• improving functional ability in people with long term conditions
• reducing time spent in hospital by people with long term conditions
• improving recovery from stroke
• helping older people to recover their independence after illness or injury

 
Adult Social Care Outcomes Framework includes:

• the proportion of people who use services who have control over their daily life
• proportion of people using social care services who receive self directed support and direct payments
• carer reported quality of life

 
The Public Health Outcomes Framework includes:

• employment of people with long term conditions
• prevalence of healthy weight, smoking, exercise rates
• quality of life for older people
• mortality rates from cardiovascular disease, cancer, liver disease, respiratory disease under 75 years of age

NICE Quality Standards

NICE has extended its role, and is due to produce 140 quality standards over the next four years. Quality standards are concise statements which will allow health outcomes for people with different conditions to be measured. The aim is for health interventions to be both of high quality and efficient. Quality standards have already been produced for specific conditions such as stroke and dementia, and quality standards for end of life care due to be produced by the end of  2011. For further information on quality standards, see http://www.nice.org.uk/guidance/qualitystandards/qualitystandards.jsp 
 

QIPP

The ‘Quality, Innovation, Productivity Prevention’ challenge continues, with the NHS expected to make £20 billion in efficiency savings over the next four years, and funding for local authorities being reduced.  Long term conditions is one of the key work streams within QIPP.
Aims include:

• to ensure services are commissioned based on a sound understanding of the needs of the local population
• integration of health and social care 
• shared decision making and self management is encouraged.  

 
Further information is available at http://www.dh.gov.uk/en/Healthcare/Qualityandproductivity/QIPPworkstreams/DH_115448  
 

The National Service Framework for Long-term Conditions  (NSF(LtC), 2005)

Although produced in 2005, the framework is still relevant and many stakeholders make reference to it, for example when auditing services for particular client groups. The Framework is available at: 
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4105361 
 
Read the COT/BAOT Briefing 36: National Service Framework for Long Term Conditions
 

National Voices

National Voices is a coalition of health and social care organisations. It aims to influence health and social policy in England, and to ensure that the voices of those who come into contact with such services are heard. More information is available at www.nationalvoices.org.uk