Community healthcare is widening the focus from just a patient’s condition to their whole life, says Stuart Shepherd

With a rapidly ageing population comes a huge rise in the numbers of people with long term health conditions - already some 15.4 million - and a challenge for commissioners of community services. The requirement? Shift care closer to home while driving up quality and productivity.

Commissioners should be having discussions with all the different providers along the pathways about the kind of joined-up personalised care services that people tell us they want

“Commissioners and providers need to share a vision for improving quality and the patient experience,” says Transforming Community Services programme director Joe Gannon. “The opportunity is there for redesigning community services around the needs of the individual with a long term condition so that they get the service they need, at all times and in all places, keeping them well, reducing the pressure on hospitals and, in the long term, making sense economically.”

A series of transformational guides across six areas, including people with long term conditions, outline the ambitions of the programme - getting the basics right every time, making everywhere as good as the rest, delivering evidence based practice, and developing and supporting high quality community services.

Ambitious specifications

“We look to commissioners to be having discussions with all the different providers along the pathways about the kind of joined-up personalised care services that people tell us they want,” says Mr Gannon.

“They should be drawing the ambitions into contract specifications, using frameworks such as commissioning for quality and innovation (CQUIN) with quality indicators measuring patient experience, timeliness of services, etc. The Stoke-on-Trent chronic obstructive pulmonary disease telehealth service is a good example of a system redesign (see case study). It is based on the needs of the individual, looks after them well and is what others should aspire to look like.”

Guidance for NHS and social care commissioners on redesigning for world class services for people with long term conditions is now available from the DH in the recently published Improving the Health and Wellbeing of People with Long Term Conditions.

Mr Gannon says: “It describes what the service should look like from the service user’s perspective, actions each part of the commissioning cycle, and examines how to overcome barriers to delivery.”

He continues: “It offers tools for assessing need, current provision and the provider’s ability to offer a broad range of responsive services. It also looks at managing demand and ensuring access, while placing a strong emphasis on clinical expertise, decision making and ownership.”

With joined-up service plans, a commissioning strategy and skilled workforce supported by technology providing quality up and down the country, the economic case for transformation will become more apparent.

Some small scale projects are already demonstrating financial benefits while doing more with less for patients with long-term conditions. A recent MS Society funded phase II trial of a fast-tracked palliative care service for 52 people with multiple sclerosis in the South East offered potential savings of nearly £1,800 per patient over three months. Similar results across the UK would save £17m per year and could be replicated for other conditions.

Local engagement

King’s College London professor of policy, palliative care and rehabilitation and project lead Irene Higginson says: “Our trial showed us the importance of offering care which focuses on the patient rather than the disease, of engaging with local services, societies and patient experts, of embedding evaluation into the trial and of integrating the service into existing services rather than making it stand alone.”

Overcoming barriers to delivery

  • Proactively create a can-do user-centred culture
  • One vision shared by all commissioners
  • Stimulate and support provider innovation
  • Assess risk using stratification techniques that use hospital and primary care data
  • Use existing ways to support people with long term conditions and carers to self care
  • Develop relevant key outcome and experience measures
  • Set clear responsibility for individuals’ wellbeing
  • Identify quick wins with IT
  • Establish information sharing protocols
  • Engage and upskill primary and community care providers

Source: Improving the health and wellbeing of people with long term conditions, DH

Case study: Stoke-on-Trent

Reduced attendances at accident and emergency around 25 per cent among a cohort of COPD patients with histories of frequent admissions are a mark of the success of Stoke-on-Trent’s tele-healthcare project. The scheme, a joint personalisation initiative, has brought together the technical know-how of the city council and the clinical expertise of the community health services.

Patients are educated in self-management, and data from monitoring equipment installed at their home can be read and assessed remotely by both community matrons and council officials. As well as ongoing review meetings, emergency visits from matrons or GPs are arranged if readings fall outside certain parameters.

Feedback from patients is excellent, with all using the system agreeing they feel less anxious about their health and are more satisfied with contact from the care provider.

The experience appears to support a shift of resources from acute to community.

“Our commissioners are building tele-healthcare into next year’s budgets as part of a balanced package of care for what have in the past been a group of high cost, high dependency patients,” says city council project lead Philip O’Connell.