Ticking time bomb means 252% increase in over 65’s with two
or more conditions by 2050
The NHS can’t afford to stand still if it is going to cope with
the increasing number of people with two or more long term
conditions – set to increase dramatically by 252 per cent by 2050
– Health Secretary Andrew Lansley said today.
Almost one in three of the population have a long term condition
- such as asthma, heart and lung disease, arthritis, hypertension
and diabetes - and half of people over the age of 60 have one.
They are the biggest users of the NHS accounting for around 50
percent of GP appointments and 70 per cent of inpatient hospital
beds meaning 30 per cent of the population accounts for 70 per
cent of the spend.
The NHS will not be able to meet this increase in demand unless
it changes. Add to that the fragmented and inefficient way the NHS
currently looks after people with long term conditions and the
health service just won’t be able to cope a few years from now.
The 15 million people with long term conditions want a different
approach – they do not want to spend time in hospital and they
want more say in the care they get and the way it is delivered.
They will all benefit from a modernised NHS by being treated more
effectively and intelligently.
The new, modernised NHS will improve the lives of people with
long term conditions by:
Giving them more support to self care – for example providing
asthmatics with new technology they can use at home to check their
lung function so they can pick up problems quickly before they get
so bad they have to go to hospital. Or empowering people to self
manage their own clotting therapy – a Cochrane study found a 50
per cent reduction in the number off blood clots and a reduction
in deaths.Remaining independent for longer using new technology –
for example telehealth and telecare technology means people can
have their vital signs monitored remotely by a health professional
and any problems can be picked up before they get serious and need
hospital treatment – in one case this has reduced the number of
days spent in hospital in one year from more than 300 to around
ten.Simplifying who cares most for a person – one professional not
five.Healthcare professionals focussing on the overall health and
wellbeing of the patient rather than just managing one of their
conditions.
Patients throughout the country are already benefitting from this:
In Ipswich a pilot project which has helped 107 patients to
better manage their own conditions has seen a 75 per cent
reduction in GP visits and a 75 per cent reduction in bed days in
hospital over a six month period. Staff are also being trained to
become health coaches to their patients.Sutton Council has
installed monitoring devices in patients’ homes so GPs can monitor
their clients’ blood pressure, blood oxygenation and other
indicators so they can take early action. A six month pilot in the
borough reduced admissions and saved around £322,000.In Swindon a
Community Matron oversees patients with long term conditions. The
Matron ensures people are educated about their condition and are
more in control and confident to cope when they feel unwell. Using
telehealth patients monitor their own blood pressure, weight and
pulse knowing that there is someone at the end of the phone if
their vital signs are not as they should be.GPs in Barking and
Dagenham are pinpointing high risk patients and giving them a care
coordinator to prevent several people going to visit a patient.
Andrew Lansley said:
“An increasing number of people are living with long term
illness, and increasingly two or more serious illnesses. The
average cost of someone without a long term condition is around
£1,000 per year, which rises to £3,000 for someone with one
condition and to £8,000 for people with three or more conditions,
the additional associated cost pressure of caring for people with
multiple co-morbidities could reach £4 billion by 2016.
“That’s one reason why we need to modernise the health service
and the way we care for patients.
“There isn’t a one size fits all solution to our health –
particularly for those who have a number of different conditions.
The modernised NHS will see local health experts in charge of
commissioning services. They will have the power and the budget to
put the overall health of their patient first – rather than having
to pigeon-hole people by individual illnesses.
“Patients don’t want to see lots of different people for lots of
different consultations – they want one team who can give them the
advice, support and care they need. The NHS in the future will
give patients better and more efficient care, keeping people well
and out of hospital.”
There is currently a very fragmented system in the NHS. Patients
who live with asthma and heart disease, for example, too often
have to see separate specialists who will see their condition in isolation.
A more streamlined, efficient NHS will see a patient having one
contact – an expert who will get other specialist advice when they
need it – but who will be the one expert assigned to a particular
patient, taking account of all their needs.
Sir John Oldham, National Clinical Lead for Quality and
Productivity for the NHS said:
“By 2050, the number of over 65s with two or more long term
conditions will have risen by 252 per cent. This means that if we
continue to manage people with long term conditions as we do now,
the NHS is not sustainable.
“We have unwittingly created a more fragmented system. Too often
it may seem that a line of case managers is queuing up outside a
single person’s house, each one dealing with a different illness.
This is sub optimal care for the patient and palpably inefficient
for the NHS.
“Patients want us to care for the whole of them and act as one
team. That’s why we are now actively making changes all across the
country with doctors, nurses, social carers and patients improving
outcomes, improving care and being more efficient.”
Better outcomes, more efficient and improved involvement. That is
what the changes are about. Transformational change that engages
people in decisions about their care in a way that helps them be
in control of their conditions not the other way around. Providing
options for how to interact with the NHS so that it becomes more
convenient and relevant to peoples’ modern lives.
All of this is possible. Using the technology at the health
service’s disposal to help people stay independent for longer,
receive care online or in their own homes, avoid unplanned
hospital admissions or unnecessary visits to clinics. Offering
different ways to communicate with health professionals means a
more streamlined efficient NHS.
Notes to Editors
1. The definition of a long term condition is any condition that
cannot be cured but can be managed by medication and/or therapy.
The General Household survey, which asks questions about long term
illness, identified a figure of 15.4 million people living with a
long term condition.
2. The Department of Health has been running the world’s largest
randomised control trial of telecare and telehealth technology
over the last two years. With over 6,000 people involved across
three sites and 238 GP practices, the Whole System Demonstrator
programme will provide an evidence base that will support decision
makers here and across the world. We expect the outcome of the
trial will become available later this year.
Contacts:
Department of Health
Phone: 020 7210 5221
NDS.DH@coi.gsi.gov.uk