NHS leaders have called for a "revolution" in the treatment of chronic and long-term conditions (LTCs) similar to that which transformed mental health care in the 1960s and 1970s.
There are 15 million patients with LTCs in England alone, representing 30% of the population, and they account for 60% of GP consultations, 30% of hospital beds and 70% of total healthcare spending, speakers told the Link Gov third annual national QIPP (Quality, Innovation, Productivity and Prevention) symposium in Liverpool last week.
Moreover, most people with LTCs have more than one such condition. For example, only 19% of people with chronic obstructive pulmonary disease (COPD) have COPD alone, and just 14% of diabetes patients are suffering from only that disease, said Sir John Oldham, National Clinical Lead for Quality and Productivity and National Workstream Lead, LTCs, at the Department of Health (DH).
Faced with this "tsunami of need," the NHS will become unsustainable if it continues treating these conditions in the same way as it does now, he warned.
Disease-specific pathways are redundant, he said. Instead, the way forward is, first, to implement a risk stratification of the population, which will reveal who are the top 5% of people most at risk, and move to personalised care plans with integrated care teams. "You can't think about disease-specificity - the data doesn't stack up," he urged delegates, and added: "Patients tell us: 'I want you to work on the whole of me, and I want you to act as one team'."
Also, the number of people who are able to self-care has to be maximised, and as the “Facebook generation” become chronic disease and LTC patients, engaging these users of the system will produce better outcomes, he added.
Work is currently underway to change the financial flows to match the change in care pathways, he said, but emphasised that the biggest issue for health care professionals will be how to transfer knowledge to patients. Currently, they are not taught how to do this and their training needs to be changed, with a greater emphasis on integrated care and self care.
Jim Easton, NHS National Director for Improvement and Efficiency at the DH, used the symposium to address senior leaders by pointing to the “extraordinary opportunities" that are available to the NHS to help tackle the challenges of chronic diseases, particularly through the use of new technologies which can unlock quality and value. However, he told the meeting: "we are undertrained to achieve this."
Within the NHS, “we have a very poor attitude to learning - we feel we have to invent everything ourselves," he said, and urged delegates: "we need to liberate ourselves as leaders and develop an awareness of knowledge - particularly technology."
And greater use of technology will not lead to mechanised care, he emphasised - rather, it will free up time for human contact and enable care to be given back to patients. "We need to re-educate ourselves and become merchants of hope," said Mr Easton.