We have known for some time that growth in Long Term Conditions is changing the shape of the demands made on the NHS. It is estimated that 17m people have a Long Term Condition. The diagram on the left is a familiar stratification of their service need.
The previous focus has been on reducing repeat admissions for those people at the very top of the pyramid - older people with complex care needs and multiple admissions; the so-called 'frequent flyers'. More recently, the larger group in the middle is gaining attention. The working assumption is that, for a range of conditions, better management in community and primary care settings can avoid admission altogether. We are also looking at the impact on Outpatient based services.
The NHS Institute has identified a group of 19 Long Term Conditions, which, if managed better in a community or primary care setting, will reduce the need for hospital admission. These are known as Ambulatory Care-Sensitive Conditions (ACSC's). Estimates of savings vary from £250 to £650m per annum. The NHS Operating Framework for 2012/13 has included a target for unplanned admission of people within this group. Some, like the King's Fund, are sceptical of the net benefits.
Our recent work has been focusing on modelling Outpatient services for people with some of these conditions. Patients still receive appropriate overall care and support from hospital based services, but the bulk of their routine care is delivered via their GP or other community based facility. Our work is showing that such changes:
- Reduce the volume of routine attendance at local hospitals, freeing up specialised services and in part assisting them in ensuring compliance with the 18 week waiting target
- Deliver a net recurring saving, even allowing for the cost of establishing new services within primary care
Elsewhere, we have looked at balancing hospital and community based services on mental health. However, the principles are easily applied to an Acute hospital inpatient environment.