PRIME Centre Wales: Long Term Conditions

A Welsh Government Perspective

Dr Dan Venables

Structure

• Health and Care Research Wales National Research Infrastructure

• The Challenge

• Primary Care Plan

• Social Services and Wellbeing Act

• Prudent Health and Care

• Health and Care Research Wales R&D policy

• Centres• Centre for Ageing and Dementia Research• Wales Centre for Primary and Emergency Care Research• National Centre for Population Health and Wellbeing Research• National Centre for Mental Health• Wales Cancer Research Centre

• Units• Brain Repair and Intracranial Neurotherapeutics Research Unit• Diabetes Research Unit• Wales Kidney Research Unit

• Clinical Trials Units• North Wales Organisation for Randomised Trials in Health• South East Wales Trials Unit• Swansea Trials Unit

• Infrastructure Support Groups• Welsh Health Economics Support Services• Secure Anonymised Information Linkage• Wales Gene Park

• School for Social Care Research

Health and Care Research Wales National Research Infrastructure 2015-17

• Chronic condition, chronic disease, life-long disease/condition, long-term disease/condition used interchangeably

• Long term conditions:• cannot be cured, only controlled, often life-long• limits quality of life• effects on carers

• Conditions include: • diabetes• asthma• arthritis• epilepsy • heart disease• stroke• cancer• respiratory health• liver disease• mental health

Long Term (Chronic) Conditions

• Changing patterns of disease - emphasis moving from young to old; from communicable to chronic

• Welsh age demographic and societal characteristics compound the effect

• Wales has the highest rates of long-term limiting illness in the UK:• 23% of people in Wales reporting at least one long term condition• 20% in Scotland and Northern Ireland• 18% in England

• Increases with age:

• two thirds of people aged 65+ report having at least one chronic condition• over 75% of people aged 85+

• Most commonly reported by adults: arthritis, respiratory conditions and heart conditions

• Prevalence (at least 1 condition) varies from 19% (Cardiff) to 30% (Merthyr Tydfil)

• Health and care needs for people with long term conditions set to increase:• Predicted increase of 32% in people aged 65+ in Wales by 2026

Designed to Improve Health and the Management of Chronic Conditions in Wales (2007)The Management of Chronic Conditions in Wales – An Update (Wales Audit Office, 2014)*

*self reported data, excludes mental health and cancer

• Accounts for a large proportion of hospital admissions:• 1 in 6 of all hospital admissions• 1 in 4 emergency admissions

• Many admissions considered unnecessary, inappropriate and avoidable

• Community support infrastructures recognised as inadequate

• Costs to the individual as well as the system: even in healthy adults, 10 days of bed rest can lead significant reductions in leg and hip muscle strength and in aerobic capacity*

Designed to Improve Health and the Management of Chronic Conditions in Wales (2007)The Management of Chronic Conditions in Wales – An Update (Wales Audit Office, 2014)

*Our Healthy Future, Chief Medical Officer for Wales Annual Report 2011

• 2008: The Management of Chronic Conditions by NHS Wales (Wales Audit Office)• Too many patients with chronic conditions treated in an unplanned way in

acute hospitals• Fragmented and poorly coordinated services• Insufficiently integrated service planning and development

• 2009: Setting the Direction• A framework for primary care and community-based services• A vision for a preventative, primary and community-led NHS• A vision for integrated community services act as a bridge between primary

and secondary care

Previous Policy

• 2014: Audit• Primary care services for people with long term conditions has improved• Support for self care has improved• Hospital admissions have fallen• Budgets for community services have increased• Workforce is being rebalanced towards the community

But…• Most community services only available on weekdays• Progress is variable and coordination could be better• Availability of information for planning and monitoring community services is limited• Performance measures continue to focus on hospitals

The Management of Chronic Conditions in Wales: An Update (Wales Audit Office, 2014)

• Develop and increase the primary care workforce

• Provide most care close to peoples’ homes

• Accelerate the transfer of services from the hospital to the community

• Improve access to services

Through:

• Investment in 10 condition-specific delivery plans to support service reconfiguration

• Developing 64 primary care clusters across Wales:

• Clusters will become increasingly accountable for the health and wellbeing of their communities

• Provision of flexible services, tailored for individuals and better matching the needs of communities

• Health boards to work with social services and 3rd / independent sectors to coordinate care through individual care plans for people with long term conditions

Our Plan for a Primary Care Service for Wales (2014);Primary Care Workforce Plan (2015)

• Co-production: empowering people to be partners in assessing and meeting their own needs

• Consider people’s strengths and assets holistically

• Provision of appropriate information and advice and self assessment will be sufficient for some people

• Resources saved can be targeted towards people with higher levels of need who require state intervention

• When professional assessment is necessary, care and support will be provided at the lowest level• Risk is managed in partnership with

people and their family or networks• Independence is maximised

Social Services and Wellbeing Act

Prudent Health and Care

• Health and Care Research Wales vision for integrated, multidisciplinary, multi-sector research

• Increasing emphasis on impact

• Increasing emphasis on evidence informed policy and practice

Health and Care Research Wales vision