Brilliant this week, to see a UK Government Health Committee report into the management of Long Term Conditions. It’s very long, over 200 pages and contains some very fine words indeed, based on a great deal of evidence gathered from a large number of organisations and individuals. It’s a fascinating read, including the transcripts of the discussions between the committee members and those giving evidence.
The committee gives its view that care for people with long term conditions cannot fit into the traditional model of health care, which is based on curable, ‘single episode’ illnesses. It says that more time is needed to hold more personalised discussions with people about their wants and needs, that the person, as well as the condition, needs to be treated, and that care planning, including results sharing and giving people access to their medical records is an appealing way forward. It urges NHS England to take note of their findings and implement new ways of long term conditions care. It seems to challenge the Government and NHS England’s response to the growing numbers and needs of people with long term conditions by describing their strategic response as unclear and insufficiently urgent.
This is very welcome news, and absolutely bears out our own experience when offering our training and skills development, which is that the rhetoric of policy is very far removed from the reality. This is particularly noticeable in relation to promoting person-centred approaches, and collaboration in care. Practitioners understand the need for this and are keen to put it into practice, but the systems that they are working in and with (for example the targets to be achieved to receive funding and payment) simply do not support it. A particular example recently has been cited in a number of our workshops. It concerns the target to reduce unplanned hospital admissions among older people. Each organisation needs to identify a certain percentage of people, upon which they are rigorously measured. It is taking up a great deal of time and effort, to the extent that trying to discuss, let alone implement, any other practices (for example care planning among the younger, able bodied) that might actually prevent people in future being vulnerable to admission, is almost impossible. The short term nature of these kind of initiatives is striking and the idea of ‘cart before horse’ often springs to mind, as does the expression ‘what gets measured, gets done’ (and, sadly, its reverse)
Two passages of the report are worthy of reproducing here as they so resonate with the above:
‘We are not convinced that focusing on measures to reduce admissions to the acute sector will effectively address the underlying issues in management of long term conditions which seem to be driving patients….into acute care (Page 5, Summary)
‘we have been struck by the mismatch between the needs of 15 million service users with one or more long term conditions, and the design of health and care system set up principally to treat and cure episodes of ill-health’ (page 43)
Although reports such as this one take time to circulate and get attention, we are at least cheered that it seems that some aspects of Government are not only listening, but hearing, and producing strong words. Seeing those words turned into action – and quickly – could really make a difference. We watch and wait, while continuing to spread the word about these important issues in our own publications. Well done, that Health Committee.
House of Commons Health Committee (2014). Managing the care of people with long-term conditions. London. The Stationary Office.
Person-Centred Practice for Long Term Conditions: a Concise Guide to Success