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Tuesday 27 September 2016
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Providing Unique Care for people with long-term conditions

Patient & Services

RUTH KENNEDY

Chief Executive
Improvement Foundation

Ruth has worked within the NHS for more than 25 years, and is currently chief executive of the Improvement Foundation, which has been successfully supporting improvement in public services over the last nine years

Currently, 15.4 million people in England, or almost one in three of the population, suffer from a long-term condition.(1)

Furthermore, the number of people in England with a long-term condition is set to rise by 23% over the next 25 years, due to the UK's ageing population.(1)

It is therefore imperative that reducing hospital admissions is a priority for all health and social care services in the UK. This is not only in terms of the costs to the NHS, but also to lessen the negative impact frequent hospitalisation has on the long-term health of people.

It has become all too common to see older people with complex health and social care needs being admitted to hospital as emergency cases because the necessary coordinated support to help them in their own homes and communities is not available. With the over-60 age group accounting for half of the recent growth in emergency admissions, and three out of every five of this group having a long-term condition, many professionals feel overwhelmed.1 This is further compacted by the shift towards primary care focused service delivery.

If emergency admissions are to be reduced, or at least contained, better management of underlying long-term conditions and more targeted support to the most vulnerable are needed.

Better integration and redesign of services, as well as emphasis on the appropriate use of skills and timely interventions, will achieve benefits for both patients and professionals.

What is Unique Care?
Unique Care, developed in the UK, is a proven, practical approach to delivering integrated care for people with multiple health needs. It is a flexible approach that works with whatever existing local structures are already in place. Working in partnership, it brings together frontline health and social care professionals, and, based on GP practice populations, focuses on the needs of the patient and their carers. Crucially, the professionals involved measure their progress and are therefore able to evaluate and demonstrate their success.

The Unique Care approach is aimed at helping older patients with complex long-term conditions within a primary care setting by coordinating an approach between health, social care and other services. It has been implemented in primary care trusts (PCTs) and general practices across the country to enable significant benefits and savings to be achieved. We at the Improvement Foundation believe that implementing integrated care is a fundamental requirement for the Transforming Community Services agenda.

The Improvement Foundation has been working with PCTs and local authorities to develop the Unique Care approach over the past five years.  Results recorded by Unique Care sites since 2006 are displayed in Table 1.

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Case study: implementation of Unique Care at St Lawrence Surgery, Worthing
St Lawrence Surgery is a practice serving 11,800 patients in the Worthing community, with a significant proportion of over-60s suffering from one or several long-term conditions.

The team were conscious of a correlation between the condition of these patients and the likelihood of them requiring secondary care. They were therefore keen to implement a method of identifying vulnerable patients in this age group that were at risk of a hospital admission, and demonstrate to the PCT that they needed to work closely with the community team to reduce these numbers.

St Lawrence Surgery, supported by West Sussex Social Care, approached the Improvement Foundation in order to implement the Unique Care approach. The intention was to help local primary and secondary care clinicians and managers, as well as social care professionals, improve and integrate care for patients with long-term conditions, with the ultimate aim of reducing hospital admissions.

Practice Business Manager Josiane Wadey and her team started off by setting up weekly hour-long meetings to review between 20–22 new and follow-up cases.

For each case discussion, patients' unmet needs were identified and tasks were allocated to the appropriate team member. A review period was set for follow-up, ensuring the patient's journey was followed until a satisfactory package of care had been implemented.

The team identified elderly patients that were vulnerable or at risk of emergency admission in a number of ways:

  • Through a predicted validation tool, they found elderly patients with a risk of emergency admission within the next year.
  • Through reviewing hospital discharge summaries of all elderly patients that had been admitted as an emergency.
  • Through accepting direct referrals from the PCT, community team and social services.
  • Since its inception in May 2007, task allocation had shown that a third of patients needed social services/low-level care, a third needed medical/nursing intervention and the final third needed no intervention.

What changes has St Lawrence Surgery seen?
The practice found that implementing Unique Care resulted not only in improved patient care and quality of life, but also greater work satisfaction among the care providers. By understanding and utilising local knowledge and experience, communication among agencies has greatly improved.

The key benefits have been:

  • Better quality of life and improved health outcomes for patients.
  • Greater choice and control for individuals over how their needs should be met.
  • Reduction in emergency admissions and emergency bed days in hospital.
  • More appropriate use of resources and a reduction in duplication of services across the system, as care is better organised.

Within the first 10-month period, St Lawrence Surgery saw a significant reduction of 20% in nonelective admissions. This resulted in the team being highly commended in the Improvement Foundation's 2008 Guy Rotherham Award (see Resources).

References
1. Department of Health. Long term conditions [homepage on website]. Available from: www.dh.gov.uk/en/Healthcare/Longtermconditions
2. Keating P, Sealy A, Dempsey L, Slater B. Reducing unplanned hospital admissions and hospital bed days in the over 65 age group: results from a pilot study. Journal of Integrated Care 2008;16(1):3-8.
3. Lyon D, Patel P, Wadey J, Adam R, Slater B. The magic of integrated care: reducing hospital admissions in the over 65s. Pre-publication draft; 2008.

Resources
Guy Rotherham Award
www.improvementfoundation.org/guyrotherhamaward

Unique Care
www.improvementfoundation.org/uniquecare