3 July 2014.
A new government report was published this week, relating to the English NHS plans to tackle long-term conditions like epilepsy with community-based care. While such care supposedly saves the NHS money, the question is: will it? bit.ly/1qG9a0u
Dont suppose wr will know till we see what this care looks like.
There is very little in the report that has not already been raised in other reports and papers produced.
There is no denying that the NHS with the cost pressures it faces cannot sustain the increased costs of treating long-term conditions in the way it currently is i.e. though occupancy of acute hospital beds.
However, what cannot be avoided are the huge barriers to delivering this model of care, including;
Specialization - long term conditions such as epilepsy are often managed by a consultant as they have specialist registry in that area. My GP does not feel sufficiently confident to alter my medications, if I feel I need a change in my medication e.g. increase then I contact my epilepsy nurse, who if necessary will discuss it with my consultant and then contact my GP to make the changes. This whole process takes about 2 weeks and involves over a GP, specialist nurse and a consultant. If community based management of specialist long term conditions is going to be successful then that knowledge and skill gap that exists must be addressed or the quality and potentially safety of care received may be compromised.
Capacity - the Royal College of GP's and BMA have already issued several dire warnings to political leaders that the chronic under funding for primary care has led to a dangerous and unsustainable model of care. Asking existing resources to undertake additional burdens will simply cause the system to buckle and again compromise the quality and safety of care provided to patients.
Commissioning - the present commissioning structure does not lend itself to integrated care models. In order to provide a coherent service, whereby a patient follows a defined and supportive care path for management then the commissioning structure (and possibly organisation structure) needs to be radically overhauled to support this (this model is already being explored in the Dalton
Overestimated? - as the article infers, the actual savings may be largely overestimated. Speaking on a personal level the instances where I've been hospitalized as a result of my epilepsy have been unavoidable or medical emergencies e.g. serious injury sustained during a seizure or status epilepticus. Neither of which could have been avoided or treated in anything other than an emergency setting. Community services may have something to offer in terms of supporting the self-management of some conditions, addressing non-compliance on medications, identification and minimizing triggers etc. However, without seeing the numbers crunched it's hard to see where the savings are coming from and whether improving community services would result in a decrease in admissions and bed occupancy.
I believe that delivering an increased amount of care for long term conditions within the community will offer benefits for patients and (potentially) some cost savings through a reduction in 'crisis admissions' and better management of some conditions with associated complications e.g. diabetes. However, there is an old saying 'to make money, you've got to spend money'. I've adapted it somewhat to 'to save money, you've got to invest money'. Without significant investment it's unlikely that there will be any tangible cost savings, and before any tax payers money is invested it would be nice to see a proof of concept or pilot study done to back these reports up with some tangible evidence (there's a worrying amount of 'estimates' in the actual report).
