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Improving the management of long-term conditions in the face of system reform

June 2006

Executive summary
Recent figures suggest that 17.5 million adults in the UK live with a long-term condition. Long term conditions include chronic diseases, physical and learning disabilities and enduring mental health problems. Three quarters of people over the age of seventy-five are estimated to live with a long term condition.

With increasing life expectancy, the number of people suffering from chronic illness is likely to increase and there is a growing consensus that healthcare needs to continue to evolve to meet this challenge. Although a policy framework to better manage conditions has been produced, this has been difficult to develop in practice because other policy priorities are commanding greater attention. Conflicting priorities include payment by results, choice, plurality, the introduction of competition, changes to commissioning and primary care structures. The continually moving ground makes it difficult to take ambitions forward in any coherent fashion.

The government’s recent white paper, Our health, our care, our say: a new direction for community services reinforces central ambitions to better manage long-term conditions. It highlights some key building blocks for change, for example new models of commissioning and the development of pathways. There is, however, no plan for how it all fits together. The aim is for new models of care to be assembled locally.

This process will not be straightforward as some apparent contradictions in policy remain. The white paper emphasises the economic imperative of managing demand and reducing inappropriate treatment, but from April the acute sector will face incentives that will point them in the opposite direction. While the white paper entreats health bodies to think of themselves as partners in the same health economy, policy encourages competition between them.

In the context of a bewildering policy agenda, this paper aims to explore how policy ambitions might be taken forward in practice by discussing four questions that are all critical to effective implementation.

• Who is best placed to commission effective pathways for those living with long term conditions?
• How can the professionals who are integral to delivering care for those with complex needs best negotiate the barriers between them?
• In what practical ways can the healthcare system best support individuals’ capacity to better manage their own health?
• How can a culture of collaboration exist in the face of competition?
• It should be noted that this paper looks at the changes to healthcare from the English perspective.

A further policy paper from the BMA highlights comparable policies between England and Scotland [go to note 1] and the HPERU paper on devolution [go to note 2] brings together the similarities and differences across all four nations.