Chronic conditions services improve but more needs to be done

26 Mar 2014 - 4:32pm

Despite reductions in relevant hospital admissions, health boards in Wales need to make more progress in expanding access to community based chronic conditions services says a report by Auditor General for Wales.

The report published today focuses on the progress which has been made on improving chronic conditions services in Wales since the publication of a previous Auditor General report in 2008.

Chronic conditions present a growing challenge to health and social services in Wales. An estimated 800,000 people report having at least one chronic condition; such as diabetes, heart disease, or chronic obstructive pulmonary disease. The prevalence of chronic conditions increases with age and its burden on the health system is likely to increase as more people live longer.

The report shows that progress has been made. Strategies published by the Welsh Government since 2008 provide a clear vision for improving the management of chronic conditions. Locally there is improved access to patient education programmes to support self-management of long term conditions. Budgets for community services have increased, there are more nurses working in a community setting, and patients are able to get quicker access to community based services. Collectively this has led to reduced hospital admissions for chronic-condition-related illnesses.

Auditor General for Wales, Huw Vaughan Thomas, said today:

It is encouraging to note the progress that has been made in developing services for people with chronic conditions. However, it is clear that more needs to be done to meet the growth in demand for chronic conditions services that will inevitably come as populations grow older. Health Boards need to maintain a focus on patient education so that self-care improves as, well as looking to expand their range of community based services. This work needs to be urgently backed up with improved information and data collection that allows service developments to be properly planned, monitored and evaluated.

However, the report also indicates where further progress is needed. In several health boards, the plans that set out how care will be shifted from hospital to community settings are insufficiently clear. Most of the community based services for chronic conditions are still only available on weekdays and there is a need to better co-ordinate the work of the different staff groups and teams that care for patients with chronic conditions. More work is also required to embed processes for identifying and supporting the patients at greatest risk of an unplanned hospital admission.

The report calls for better information to plan and monitor the delivery of chronic condition services. Much of the information currently available focuses on hospital activity rather than services in the community, and the boards of NHS bodies receive insufficient information to help them gauge the quality, efficiency and effectiveness of community based services. The report argues that this will need to change in order for NHS bodies to have a clearer idea of what types of future service developments represent the best value for money.

The report makes a number of recommendations, including the need for:

  • health boards to develop plans that more explicitly state how services will be rebalanced towards the community;
  • a more systematic approach to identify patients at risk of an unplanned hospital admission, based upon sound evaluation of existing approaches;
  • clearer responsibilities for co-ordinating the care that patients with chronic conditions receive; and
  • better information systems and data sharing to support the planning and delivery of community based care services.