Putting patients first: making a success of the Major Conditions Strategy
The challenges our healthcare system faces are immediate and obvious. Long waits for operations, the difficulties of seeing a GP, queues in Accident and Emergency departments. This winter is likely to be one of the most challenging the NHS has ever seen.
This article and The Forgotten Majority? A new policy framework for improving outcomes for people with long-term conditions report have been commissioned and funded by AbbVie. This article is intended for the general public.
For national policymakers and health system leaders the last three years have been dominated by the pandemic and short term fire-fighting. With record backlogs of care, a stretched workforce and a lack of capital investment the ability to deliver improved services and patient outcomes in the future can feel out of reach.
However, this crisis presents an opportunity for change, to work differently and challenge the status quo. Such change is imperative to meet the more complex and varied long-term health needs of the population.
Our new report at Future Health, The Forgotten Majority?, commissioned by AbbVie, finds that 25 million people in England are estimated to have one long-term condition and 13.4 million people now have two or more. This is placing increased pressures and challenges on health services1. People with long-term conditions account for 50% of GP appointments and 70% of hospital beds2. A patient with one condition is estimated to cost £3,000 per year, a patient with three conditions £8,0003. In total our research finds that long-term health conditions are costing healthcare services a staggering £115.2 billion a year.
Regionally the impact is not equally distributed. Four of the five health systems with the highest estimated proportions of people with multiple long-term conditions are in the South West – Cornwall and Isles of Scilly, Somerset, Dorset and Devon – with rates of 27% or more1.
Health services, particularly in hospitals have traditionally been designed to deal with patients with a single disease. But for a growing number this is no longer a suitable model of care. For many years primary care has been at the forefront of delivering more person centred and whole-person care. But many of the existing policy measures and incentives within it are outdated and aimed at managing single diseases.
For patients the result is a mixed experience of care. Recent data from the Patients Association found that only a third of patients said their care had been well co-ordinated with a third disagreeing. 40% felt they had been kept informed about what was happening to their care, a third did not. Two in three patients struggled to access at least one of the services they needed4. There is also a wider impact. The number of people out of the labour market due to long-term sickness has increased sharply since 2019 restricting efforts to increase economic growth5.
The Government’s forthcoming Major Conditions Strategy presents an opportunity to address this6.
To succeed, the Strategy will need to learn from past efforts, line-up closely with changing population health needs and be appreciative of the context in which it is landing.
Our report finds a mixed picture of performance in efforts to improve care for people with long-term conditions over the last two decades through either primarily top-down or more dispersed and bottom-up approaches1. There is also understandable scepticism about whether a policy document landing in the current difficult circumstances can really deliver.
Perhaps most fundamentally, the Strategy presents an opportunity to build policy differently by putting patient and patient needs at the centre of the framework. Other countries such as Denmark are embracing a more patient centred and less condition centred approach7. The establishment of Integrated Care Boards regionally also creates a new delivery model to work with and through to succeed.
The Strategy has evolved since it was first announced in January, but the proposed design framework continues to put a set of conditions (cancer, cardiovascular disease, dementia, mental health, musculoskeletal conditions and respiratory disease) as priorities. Such a traditionalist, silo-ed approach to policymaking jars with the stated ambitions of the strategy for genuinely integrated, patient centred care and the changing complex long-term health needs of the population.
Given current NHS pressures, people might dismiss the Major Conditions Strategy as an irrelevance or at worst distraction. However, if got right it could be the basis of a new model for improving services between the centre, the regions, systems and patients. But to do so will require putting patients rather than conditions first. As the Government finalises the strategy in the next few weeks it should go all in and embrace a patient first approach.
1. Future Health. The forgotten majority? A new policy framework for improving outcomes for people with long-term conditions. To be published December 2023
2. NHS England. Making the case for the personalised approach. Available at: https://www.england.nhs.uk/blog/making-the-case-for-the-personalised-approach/ [Last accessed October 2023]
3. NHS England. The NHS belongs to the people: A call to action. July 2013. Available at: https://www.england.nhs.uk/wp-content/uploads/2013/07/nhs-belongs.pdf [Last accessed October 2023]
4. Patients Association. Survey of patients paints a mixed picture of experiences. March 2023. Available at: https://www.patients-association.org.uk/blog/survey-of-patients-paints-a-mixed-picture-of-experiences
5. Office for National Statistics. Half a million more people are out of the labour force because of long-term sickness. Available at: https://www.ons.gov.uk/employmentandlabourmarket/peoplenotinwork/economicinactivity/articles/halfamillionmorepeopleareoutofthelabourforcebecauseoflongtermsickness/2022-11-10 [Last accessed October 2023]
6. Department for Health and Social Care. Major conditions strategy: case for change and our strategic framework. August 2023 Available at: https://www.gov.uk/government/publications/major-conditions-strategy-case-for-change-and-our-strategic-framework/major-conditions-strategy-case-for-change-and-our-strategic-framework--2 [Last accessed October 2023]
7. Healthcare Denmark. Chronic diseases and multimorbidity in Denmark. Available at: https://healthcaredenmark.dk/media/fabhotbl/3i-chronic-uk.pdf [Last accessed October 2023]
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