Audit Scotland - Managing long term conditions

Introduction
The report refers to long term conditions in general and specifically focuses on chronic obstructive pulmonary disease (COPD) and epilepsy. These were selected as there has been little evaluation of them compared to other long term conditions such as diabetes or asthma. There is only one specific mention of dementia in the report, relating to a good practice example by Falkirk Council using innovative technology to assist people to stay at home.

Part 1 – setting the scene

• Outlines the scale of long term conditions, their projected growth and the burden that this places on the health care system.
• Review found that services for people with long term conditions are improving but there is considerable progress to be made.
• Recommendations included in the report will be followed up by external auditors based on self assessment checklists for NHS boards.

Part 2 – activity, cost and effectiveness of services

• The amount of social care provided to people with long-term conditions is unknown. Social care data does not identify disease-specific information, making it impossible to quantify activity.
• There is limited information at a Scotland wide level about the cost of services to support the major decisions involved in changing services for people with long term conditions.
• There has been very little evaluation of the cost-effectiveness of services for people with long term conditions. This gap urgently needs to be filled, as decisions on the use of resources are being made with limited evidence about what works for patients.

Recommendations:

• The SEHD, NHS boards and local authorities should collect better information on activity, cost and quality of services for long term conditions to support the development of community services.
• The SEHD, NHS boards and local authorities should evaluate different ways of providing services to ensure cost-effectiveness and share good practice.

Part 3 – shifting the balance of care

• There are a number of practical barriers to providing better community services for all patients with long term conditions. There is a need to join up health and social care provision more effectively, ensure that relevant staff have access to comprehensive information on people’s care needs and introduce real incentives for change.
• In Scotland there are no explicit targets for shifting the balance of care into community based services and there are limited financial incentives.
• Good partnership working is a key factor in shifting the balance of care and improving services for people with long term conditions. Whilst there are examples of good joint working for particular conditions, more needs to be done to make partnership working more effective regardless of where a person lives or what condition they have.

Recommendations include:

• NHS board and local authorities, through CHPs, should ensure comprehensive information is given to patients about their condition, and the health and social care services available, at the time of diagnosis.
• SEHD and NHS boards should agree targets to support the development of community based services.
• SEHD should prioritise work on developing systems to ensure that comprehensive information on patients is available to all professionals so they can assess and manage the total care package for each individual – a timescale should be set for this.

August 2007

The full report is available on the Audit Scotland website
Full report