Michael Wright, Programme Director, Guy's and St Thomas' Charity
Aug 16, 2017
Last month Public Health England published its Health Profile for England. The data shows that, as life expectancy increases in the UK, so does the number of years lived in poor health. Meanwhile, the burden of morbidity (living with disease) increased by nearly a sixth between 1990 and 2013.
These figures are an important reminder to all of us working to understand and tackle poor health. It tells us that this is, after all, about life lived with as much quality as possible, for as long as possible.
In this context, it feels particularly pressing to find a way forward for the increasing numbers among us living with long-term conditions – particularly those living with several of them.
Since the start of this year I’ve been exploring what role a foundation like ours could play in helping to tackle the growing issue of multiple long-term conditions. In my previous blog, I outlined the main reasons behind our decision to act on this issue by creating a new programme of work.
During the discovery phase of our programme, I’ve found that there is limited high quality evidence on the effectiveness and impact of any of the models of care in tackling multiple long-term conditions.
This is partly, I believe, because much of the evidence is emergent, including from sources like the NHS England Vanguards, Sustainability and Transformation Plans (STP) new models of care and other formative evaluations of new care models.
Still, previous research provides some useful pointers.
A Europe-wide study examined over a hundred care programmes that target patients with multiple long-term conditions and identified features common to all care programmes. They all showed patient-centeredness, an emphasis on coordination of care, improvement of collaboration between (multidisciplinary) caregivers and a defined focus on outcomes. In addition, it looked like the most successful programmes were happening at the local level.
In parallel, Cochrane’s review in 2016 of 18 randomised controlled trials, suggests that interventions may be more effective when designed to target speciﬁc risk factors or interventions that focus on difﬁculties that people have with daily functioning.
This is echoed by Arthritis UK in its recent report on the impact of musculoskeletal health on people with multiple long-term conditions. People say that having good muscle and bone health, to be able to open pill packets, change dressings and travel to doctor appointments, improves their quality of life considerably.
In general, NHS England’s 44 STPs lack detailed information on the design of models of care. However, they do indicate that care based locally, better management of patients at risk and multidisciplinary teams are key to improving care for individuals with multiple long-term conditions. All point to integration of data across providers as key and outline digital roadmaps, although today only a few examples exist where this integration has been achieved.
The new models of care being tested across the UK provide a source of potential evidence. They generally fall into two types. Broadly described, in Multispecialty Community Providers (MCPs), GP practices come together and collaborate with other health and social care professionals to provide more integrated services outside of hospitals. Meanwhile, in Integrated primary and acute care systems (PACs) a single entity takes responsibility for delivering the full range of primary, community, mental health and hospital services.
Both have their merits and some areas where these are being tested are already showing promising results. Keeping a close eye on these will continue to be part of my role as we develop our approach.
Understanding what they feel, how they experience care and how they’d like their lives and practice to be will be crucial to getting a new model right. One that allows us to keep our increasingly longer lives as healthy as possible.