PRIME Centre Wales Long Term Conditions Consensus Meeting Tuesday 10th November 2015, St Mary's Priory, Abergavenny, NP7 5ND http://www.primecentre.wales/ltc-consensus-meeting.php

1. PRIME Centre Wales: Long Term Conditions
A Welsh Government Perspective
Dr Dan Venables

2. Structure
• Health and Care Research Wales National Research Infrastructure
• The Challenge
• Primary Care Plan
• Social Services and Wellbeing Act
• Prudent Health and Care
• Health and Care Research Wales R&D policy

3. • Centres
• Centre for Ageing and Dementia Research
• Wales Centre for Primary and Emergency Care Research
• National Centre for Population Health and Wellbeing Research
• National Centre for Mental Health
• Wales Cancer Research Centre
• Units
• Brain Repair and Intracranial Neurotherapeutics Research Unit
• Diabetes Research Unit
• Wales Kidney Research Unit
• Clinical Trials Units
• North Wales Organisation for Randomised Trials in Health
• South East Wales Trials Unit
• Swansea Trials Unit
• Infrastructure Support Groups
• Welsh Health Economics Support Services
• Secure Anonymised Information Linkage
• Wales Gene Park
• School for Social Care Research
Health and Care Research Wales National Research Infrastructure 2015-17

4. • Chronic condition, chronic disease, life-long disease/condition, long-term
disease/condition used interchangeably
• Long term conditions:
• cannot be cured, only controlled, often life-long
• limits quality of life
• effects on carers
• Conditions include:
• diabetes
• asthma
• arthritis
• epilepsy
• heart disease
• stroke
• cancer
• respiratory health
• liver disease
• mental health
Long Term (Chronic) Conditions

5. • Changing patterns of disease - emphasis moving from young to old; from communicable to
chronic
• Welsh age demographic and societal characteristics compound the effect
• Wales has the highest rates of long-term limiting illness in the UK:
• 23% of people in Wales reporting at least one long term condition
• 20% in Scotland and Northern Ireland
• 18% in England
• Increases with age:
• two thirds of people aged 65+ report having at least one chronic condition
• over 75% of people aged 85+
• Most commonly reported by adults: arthritis, respiratory conditions and heart conditions
• Prevalence (at least 1 condition) varies from 19% (Cardiff) to 30% (Merthyr Tydfil)
• Health and care needs for people with long term conditions set to increase:
• Predicted increase of 32% in people aged 65+ in Wales by 2026
Designed to Improve Health and the Management of Chronic Conditions in Wales (2007)
The Management of Chronic Conditions in Wales – An Update (Wales Audit Office, 2014)*
*self reported data, excludes mental health and cancer

6. • Accounts for a large proportion of hospital admissions:
• 1 in 6 of all hospital admissions
• 1 in 4 emergency admissions
• Many admissions considered unnecessary, inappropriate and avoidable
• Community support infrastructures recognised as inadequate
• Costs to the individual as well as the system: even in healthy adults, 10 days of
bed rest can lead significant reductions in leg and hip muscle strength and in
aerobic capacity*
Designed to Improve Health and the Management of Chronic Conditions in Wales (2007)
The Management of Chronic Conditions in Wales – An Update (Wales Audit Office, 2014)
*Our Healthy Future, Chief Medical Officer for Wales Annual Report 2011

7. • 2008: The Management of Chronic Conditions by NHS Wales (Wales Audit Office)
• Too many patients with chronic conditions treated in an unplanned way in
acute hospitals
• Fragmented and poorly coordinated services
• Insufficiently integrated service planning and development
• 2009: Setting the Direction
• A framework for primary care and community-based services
• A vision for a preventative, primary and community-led NHS
• A vision for integrated community services act as a bridge between primary
and secondary care
Previous Policy

8. • 2014: Audit
• Primary care services for people with long term conditions has improved
• Support for self care has improved
• Hospital admissions have fallen
• Budgets for community services have increased
• Workforce is being rebalanced towards the community
But…
• Most community services only available on weekdays
• Progress is variable and coordination could be better
• Availability of information for planning and monitoring community services is limited
• Performance measures continue to focus on hospitals
The Management of Chronic Conditions in Wales: An Update
(Wales Audit Office, 2014)

9. • Develop and increase the primary care workforce
• Provide most care close to peoples’ homes
• Accelerate the transfer of services from the hospital to the community
• Improve access to services
Through:
• Investment in 10 condition-specific delivery plans to support service reconfiguration
• Developing 64 primary care clusters across Wales:
• Clusters will become increasingly accountable for the health and wellbeing of their
communities
• Provision of flexible services, tailored for individuals and better matching the needs
of communities
• Health boards to work with social services and 3rd / independent sectors to coordinate
care through individual care plans for people with long term conditions
Our Plan for a Primary Care Service for Wales (2014);
Primary Care Workforce Plan (2015)

10. • Co-production: empowering people to be
partners in assessing and meeting their
own needs
• Consider people’s strengths and assets
holistically
• Provision of appropriate information and
advice and self assessment will be
sufficient for some people
• Resources saved can be targeted towards
people with higher levels of need who
require state intervention
• When professional assessment is
necessary, care and support will be
provided at the lowest level
• Risk is managed in partnership with
people and their family or networks
• Independence is maximised
Social Services and Wellbeing Act

11. Prudent Health and Care

12. • Health and Care Research Wales vision for integrated,
multidisciplinary, multi-sector research
• Increasing emphasis on impact
• Increasing emphasis on evidence informed policy and practice
Health and Care Research Wales vision