Charities are getting more bullish about saying how they can deliver care and savings in health, says Emma Dent
Services provided by the voluntary sector lead to support of an emotional and practical nature, more coordinated care, patients being more engaged in their care. They support self management and improve prevention of illness.
So says the report How to Deliver High-Quality, Patient-Centred, Cost-Effective Care - consensus solutions from the voluntary sector, compiled by 10 charities that each provide services for long-term conditions.
However, the message is in danger of getting lost, says Macmillan Cancer Support head of campaigns, policy and public affairs Mike Hobday. The cancer charity led the compilation of the report.
He says: “All the charities [involved] were feeling very frustrated at the way in which, at a local level, the NHS is looking to make savings over the next three years. There is a lot of short term thinking and cutting back on effective services, a real danger that the NHS could go a long way backwards.
“So we drew together a number of evidenced examples about the voluntary sector providing interventions that are effective in terms of cost and quality.”
Mr Hobday admits that historically the voluntary sector has underplayed its ability to influence policy. But this is something that has to change if services that achieve local success are to be scaled up to a national level.
“Scaling up is the real challenge. Locally NHS managers are the target but they face huge time pressures. And we need dialogue at a national level - we are looking at National Institute for Health and Clinical Excellence quality standards and to the NHS framework - and want to see commissioning bodies include a genuine patient representative.”
Although a number of schemes outlined in the report have achieved cost savings for local services, Mr Hobday says it is difficult to put a figure on what could be saved nationally.
But he adds: “It was particularly striking that the issues are the same, regardless of which long term condition you are working with. These interventions are good for patients, the NHS and the Treasury.”
What the voluntary sector says it can deliver
Co-ordinated care Care planning, co-ordinated care for people with multiple conditions and services that aim to provide case management and co-ordination roles are said to still be ineffectively delivered, despite policy ambitions.
The British Heart Foundation’s heart failure nurses and the Stroke Association’s Life After Stroke service are named in the report.
BHF heart failure nurses provide care, support and education to patients with a range of heart conditions. Seeing patients in their own home and in clinic, they have been found to reduce hospital admissions by up to 35 per cent.
Patients engaged in decisions about their care Engaging patients and carers in decisions about treatment can improve condition management, improve patient experience of care and link commissioning decisions to service user needs.
Initiatives adopted by breast cancer units involved in Breakthrough Breast Cancer’s service pledge scheme include a “buddying” system, where patients talk to others who have undergone the same treatment and offering patients the chance to see photographs of the results of surgical procedures.
Supported self-management Personalised action plans, access to health professionals and specialist advice, schemes that provide emotional, psychological and practical support and education schemes all enable people with long-term conditions to manage them better.
Structured education and information schemes, such as those provided to patients with asthma by Asthma UK services have improved patients’ ability to access support from their GP and specialist clinics and reduced visits to accident and emergency.
Prevention, early diagnosis and interventionPublic health services and prevention schemes are needed to ensure the quality of people’s lives is improved and long-term savings made.
The Love Your Lungs campaign run by the British Lung Foundation aims to raise awareness of COPD and its symptoms, in areas where the population has high rates of the disease. A campaign in Hull saw a quarter of those receiving a lung test being referred for a follow-up consultation, with one third of those subsequently being diagnosed with COPD.
Making such a diagnosis while the disease in its early stages is believed to make savings in terms of avoided treatment and accident and emergency admissions.
Support for those with long-term or acute illness Befriending and buddying schemes, face to face and helpline schemes, support and respite for carers, schemes to help patients re-connect with their communities and aids to help people live in their own homes with disabilities can all help.
Mental health spending on clients who found work with the support of an individual placement support service fell by 60 per cent. The employment rate of IPS schemes, at 61 per cent, is over twice the rate of traditional employment schemes.