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Long term conditions demand long term solutions

 

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Sunday, 28 March 2010

Long term conditions demand long term solutions

One of the unintended consequences of better healthcare is long-term pressure on the system

One of the unintended consequences of better healthcare is long-term pressure on the system. Each week, life expectancy increases by a day. Babies born in 2010 can be expected to live to receive a telegram from the monarch, so long as telegrams and monarchs survive another century.

Long term conditions affect more than 15 million people in England at an annual cost to the NHS of billions of pounds. Over the next quarter of a century the number of people with long term conditions will rise by an estimated 23%.

The social and financial implications are potentially dire. The solutions will have to be radical and will mean wholesale changes to the health system and the design of care pathways. Fiddling at the margins won’t do it.

The challenge for people with long term conditions is to keep them out of hospital. This is a win for the patient, who would rather be at home and a win for the NHS, which has urgent economic incentives to accede to this wish. Patients with long term conditions account for very nearly half of all in-patient hospital bed days.

One possible solution is to increase the use of telehealth – remote diagnostics and monitoring systems that support patients in caring for themselves.

These systems have been used successfully to monitor patients with heart conditions, asthma, high blood pressure, COPD and a range of other conditions. They have their detractors, who worry about the risks of leaving patients to care for themselves. They have other detractors who worry about the risks to careers and reputations when systems occasionally fail, as inevitably they do.

There is anecdotal evidence of fantastic gains to be made using telehealth. In extreme cases, we hear about patients used to all year round hospitalisation reduced to near normal levels of attendance.

Trials report evidence that not only are these approaches cost effective, they are also clinically effective. Most importantly, the quality of life of patients and their families improves when care moves closer to home.

The problem is that none of these benefits is scientifically proven. A few relatively small trials have produced encouraging results, but for those results to be turned into benefits at scale requires either more substantial evidence or a leap of faith.

Today, less than 10,000 people in the UK use telehealth. Research suggests that perhaps as many as 3 million could benefit from wider use of the technology. The resulting cost savings, even assuming a modest change in the use of existing services, could run into billions of pounds.