Better management of chronic conditions key to unlocking many NHS pressures

We all probably know that Wales has an increasingly ageing population. While it’s great we’re living longer, the down side to this is that more and more of us will probably end up living with one or more long term health problems typically known as “chronic conditions”.

Many different health problems fall under the category of a chronic condition. They include diabetes, heart disease, lung and breathing problems and arthritis.  They affect individuals in many different ways but what most of them have in common is the fact that the condition can’t be cured – only controlled.

The way in which health and social care services help people control their chronic condition has a real bearing on the demands placed on the NHS. If you’ve got a chronic condition, and your health worsens, you will often need to access services in an urgent and unplanned way. This can put a real strain on NHS “unscheduled” care services. More generally,  if you have a chronic condition, you are twice as likely to spend time in hospital than a patient without one.

That’s a lot of hospital admissions when you add it all up, because, according to figures by Public Health Wales, 800,000 people in Wales – have at least one chronic condition. And, a third of over-65’s in Wales suffer with multiple chronic conditions.

With the Welsh Government forecasting the number of people aged 65 and over increasing by 32 per cent between 2010 and 2026, the pressures on the NHS are set to get worse. So, it’s understandable that solving the growing pressures that chronic conditions bring to the NHS is like finding the holy grail of public health management.

Here at the Wales Audit Office, we’ve been looking closely at how Wales is doing in managing chronic conditions. This week, the Auditor General for Wales published an update report , which follows up on previous work we reported in 2008.

Back in 2008, we found that too many patients were being treated in an unplanned way in acute hospitals, accounting for one in six of all emergency medical admissions and 17 per cent of bed days on acute medical wards. Services were fragmented and poorly coordinated, and service planning and development was insufficiently integrated.

The good news is that our report this week shows some improvements and hospital admissions for certain key conditions have reduced. NHS bodies now have a clear vision for transforming chronic condition services by shifting resources from hospitals to the community sector, and are starting to make progress in delivering this vision

Helping people to manage their condition (self-care) and then providing the appropriate range of community services for chronic conditions really is the one of the key ways in which the NHS can manage the growing demand for its services.

Whilst our report points to important progress, we have also shown that more needs to be done.  The planning process  which sets out how NHS bodies will  shift more care to the community needs to more sophisticated. More community based services need to be available in the evenings and weekends and not just on weekdays; and healthcare professionals need systems in place to help them identify the patients at higher risk of becoming unwell. . The Auditor General makes a number of recommendations designed to help the NHS improve on this, and other aspects of chronic conditions management.

We hope our report will help provide a focus for continued improvement. And that’s got to be good, not just for those working in the NHS, but for the growing numbers of people living with chronic conditions, who can be treated in their communities and homes with less need for hospital visits.

You can read the full report on our website. You might also find our recent report on unscheduled care services in Wales useful reading.

About the Author:

Photo of Gabrielle Smith

Gabrielle Smith is a Performance Audit Lead at the Wales Audit Office and was part of the study team working on the Chronic Conditions Management report, which was published on 27 March 2014.

Gabby is a registered nurse and has worked in external audit for 14 years, having previously held posts at the Audit Commission and Healthcare Commission.

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