Care for people with long-term conditions is improving but more needs to be done

The NHS in Scotland can improve the care it gives to people with long-term illnesses by better targeting resources, further developing community-based services and driving a national strategy.

An Audit Scotland report published today, Managing long-term conditions, finds that care for people with chronic illnesses is improving but the health service, councils and the Scottish Executive need to do more to build a joined-up system of care. Audit Scotland’s report also finds that patients want better information about their conditions and more say in their own care.

A lack of information about costs and activity means many decisions on the use of resources are made with limited evidence about what works for patients. The NHS and councils need to urgently address this in order to meet its aims of effectively developing more services based in the community.

Audit Scotland director of public reporting Barbara Hurst said: “Care for people with chronic illnesses is improving but there is more that the Scottish Executive, the NHS and councils can do. There have been many improvements in various clinical areas in different parts of Scotland.

However these are often local projects, driven by local need or enthusiasm rather than by a national strategy. The Scottish Executive, health boards and councils need to do more to make improvements nation-wide and to create joined-up services.

“The NHS and councils should try to get a better understanding of the true cost and the scale and types of activity in this area so they can better plan how to develop services and target resources. This is an area of particular priority given that demographic changes mean that there are likely to be more people living with long-term conditions.”

It is estimated about a million people in Scotland have at least one long-term condition. In the UK it is estimated that people with long-term conditions account for 80 per cent of all GP consultations and for more than 60 per cent of hospital bed days.

Scotland’s ageing population means the numbers of people with chronic illnesses is expected to rise markedly over the next 20 years, as the prevalence of many long-term conditions increases with age.

However estimating how much the NHS spends on long-term conditions is difficult. The Audit Scotland report focuses on two conditions; chronic obstructive pulmonary disease (COPD) and epilepsy. In 2004/05 the NHS spent at least £98.5m on COPD. This is an underestimate of the total cost due to a lack of information about social work costs, services provided by the voluntary sector and families, and full prescribing costs. Similarly, epilepsy cost a minimum of £38m in the same year.