Martin McShane is a former GP and commissioner who is now Director for Domain Two of the Outcomes Framework for NHS England. He shares his vision for the future of long-term conditions management in the NHS in England.
Working for high quality care for all
NHS England has been described as one of the biggest start-ups in the world since it launched five months ago and we’ve been on an interesting journey.
I am one of the five domain directors for the NHS Outcomes Framework. I bring my clinical experience and system knowledge to bear on improving the quality of life for people with long-term health conditions.
A person-centred approach
The management of long-term conditions is the biggest challenge facing healthcare systems worldwide. They account for 70% of health and social care costs in England. In the narrative for my domain, I use a metaphor, the House of Care, to describe the integrated, person-centred approach we need to take to tackle this problem.
The foundations of the House of Care are built on commissioning which needs to be thought of as a quality improvement cycle, not just contracting.
The roof is built with the best organisational and clinical processes. This is about implementing what we know works, including NICE guidelines and quality standards. However, the most important changes we are seeking are the pillars of the House of Care.
The first pillar is built with truly empowered patients and carers. We’ve been making steps toward this but it requires a massive cultural shift. National Voices, the coalition of health and social care charities in England, have fed back on what is required to start making care more coordinated.
There are many ways we can give people more control. For instance, using personal budgets, giving people access to their records and through shared decision making. It is about listening to what is important for patients and building care around their goals, as well as their needs. We have lost sight of that and need to recapture the human touch.
The second pillar of the House of Care is professional collaboration. We need to link care information. Not only will this improve care for individuals, it will allow us to track the impact of our interventions. We will also be able to better see the value of what generalists and specialists do. For example, both contributed to the fact that between 2001 and 2010 cardiovascular mortality declined by 40% in under 75s in England.
Current incentives, and the way we use information to support professionals to collaborate, need to be radically overhauled.
Initiatives like the Integrated Care and Support Pioneers, which is bringing local health and social care providers together, offer an exciting opportunity to discover how to forge a new approach. NHS England’s ‘call to action’ is also important as it is intended to engage people in the need to recognise the scale of change required to meet the challenges the NHS faces.
We need to recognise that long-term conditions have become more complex. GPs will tell you that more people have multiple conditions and are older, yet guidance is often based on research that excludes comorbidity and this group of people.
This is why the House of Care approach is about building care around the person, not making a person fit the care.
An exemplar system to manage long-term conditions
The House is just the starting point. We should think about how communities can support long-term conditions too. A good example is the ambition to create dementia friendly communities. And we can do this by bringing professionals from across the health, social care and third sector together, as we will do at our Future of Health conference on 3 and 4 October. There I’ll talk more about the House of Care and what is needed.
I believe that the 21st century needs anticipatory care – the 20th century was very much about reactive care. I’m optimistic about the potential of the NHS, as one of the greatest health systems in the world, to make this happen. We have the wherewithal to deliver an exemplar system to manage long-term conditions. But the scale of the challenge and the change required cannot be underestimated.
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