15 million patients with long-term conditions (LTCs) currently account for 70% of annual NHS expenditure in England, and it is estimated that treating LTCs will require the NHS to find £4 billion more every year by 2016, MPs warn.
And this is at a time when the NHS budget is barely increasing in real terms and local authority social care budgets have been cut by £2.6 billion, says the House of Commons Health Committee, reporting on its recent major inquiry into managing the care of people with LTCs.
Increasingly, patients are living with two or more LTCs, which complicates treatment and adds to its cost. Also, these multimorbidities are not adequately recognised in a system which is overwhelmingly set up to address single diseases, say the MPs.
The Committee strongly supports the development of individual care planning for LTCs based on the NHS House of Care programme, which includes supporting people to manage their own condition. This will give patients greater say in their treatment and enable them to discuss what works best for them, it says.
The MPs also find that the prevailing view - that services to treat LTCs should be moved out of hospitals and into primary and community care - might lead to more effective care, but that the case for economic benefits to the NHS is not yet proven. In fact, to provide effective care for these conditions, services must be maintained across all settings, and many conditions will continue to require specialist services delivered in hospital, they say.
Moreover, the focus on treating fewer people with LTCs in hospital is the wrong one – what the government and NHS England should be addressing are the factors which drive these patients into acute hospitals through A&E in the first place, they state.
System incentives need to be thoroughly revised to give proper support for care planning approaches, they say, and point out that Monitor and NHS England have fallen behind in developing proper alternatives to the payment by results tariff which is designed for delivering individual episodes of care, not for managing LTCs.
They note that NHS England has moved away from developing a national strategy for managing LTCs, and call for clarity on how cross-government working on LTCs will now be achieved, and on the strategy objectives for LTCs which NHS England has now adopted.