Greater Manchester Health & Social Care Partnership VCSE Long-Term Conditions Workshop 15 September 2017

treatment/therapies.” What are Long Term Conditions? “A long term condition (LTC) is a condition that cannot, at present, be cured but is controlled by medication and/or other treatment/therapies.”

How LTCs Affect The System It is estimated that there are 15 million people in England with a Long Term Condition. Of those people who report that they live with Long Term Conditions; 24% have two Long Term Conditions 20% have three or more Long Term Conditions People with Long Term Conditions account for1: 50% of all GP appointments 64% of outpatient appointments 70% of all inpatient bed days In total, around 70% of the total health and care spend in England (70p in every £1) is attributed to caring for people with LTCs This means that 30% of the population account for 70% of the spend Department for Health (2012) Long term conditions compendium of information third edition People with long term conditions continue to see variation in care and services across the country. They are intensive users of health and social care services, including community services, urgent and emergency care and acute services. Based on the estimate that 15 million people in England have a LTC, this infers that more than 750,000 people across GM have a LTC

LTCs In Greater Manchester Hypertension, Depression, Asthma and Diabetes are the most prevalent Long Term Conditions across Greater Manchester (QOF, 2015/16) GM broadly in line with regional and national levels for the proportion of people on disease registers, however there is wide variation within GM amongst the CCGs, e.g. Hypertension ranges between 10.3% in Manchester CCG and 15.9% in Wigan Borough CCG. COPD prevalence is substantially higher in GM (and the North) than England as a whole. All 10 CCGs have higher prevalence for this condition than England. If COPD prevalence in GM was the same as England, there would be 12,000 less people with COPD across GM. Work undertaken by Public Health England suggests that there are 276,700 more people with hypertension across GM who have been undiagnosed, this means that the total number of people with hypertension in GM is more likely to be closer to 675,000. Hospital admissions due to asthma in children aged under 19 are significantly higher in GM than the whole of England (true for 9 of the 10 CCGs in GM). There were 2,386 admissions due to asthma in 2015/16 for children aged under 19 (almost 200 per month). The GM rate was 364 admissions per 100,000 population compared to 202 per 100,000 across the whole of England. Although data is not available for 2015/16, hospital admissions for asthma in children aged under 10 is available for 2014/15. A similar pattern emerges with 8 out of the 10 CCGs in GM having a rate significantly higher than England as a whole. In total, there were 1,832 admissions during 2014/15 (approx. 150 per month).

LTC Prevalence across GM by GP Practice So the following screenshots delineate the following conditions which I reckon are long term conditions.   Asthma, AF, Cancer, COPD, Chronic Kidney Disease, Dementia depression, diabetes, epilepsy, heart failure hypertension, heart failure, hypertension, mental health, ospteporoiss, peripheral artery disease, stroke, rheumatoid arthritis and learning difficulties.

LTC % Treated across GM by GP Practice Of those on the slide before, percentage of patient treated (based on QOF). In general, the prevalence is increasing but how well people are being treated (in QOF terms is more patchy).

Wider Impact of LTCs The population is ageing and age is a major factor in the prevalence of Long Term Conditions, including multiple Long Term Conditions 14% of people aged under 40 with a Long Term Condition 58% of people aged 60 or over with a Long Term Condition Increase in the number of people with multiple Long Term Conditions Link with Long Term Conditions and Socio-economic status Financial pressures on Health and Social Care People with LTCs are most intensive users of expensive services LTCs not just a health issue, they affect the ability to work or lead a full life 63% of people aged 16-64 with a Long Term Condition are in employment (compared to 75% of the population as a whole) With increasing prevalence of LTCs, in particular people having two or more conditions, and the financial pressures facing the NHS in the coming years, doing more of the same will not be good enough. 25% of people aged 60 or over have 2 or more Long Term Conditions Average cost of Health and Social Care per year is approximately £1,000 for people with no LTC; £3,000 for people with one LTC £6,000 for people with two LTCs £7,750 for people with 3+ LTCs LTCs are not just a health issue they can have a significant impact on a person’s ability to work and live a full life. People from lower socio economic groups have increased risk of developing a LTC – better management can help to reduce health inequalities.

COPD over Air Pollution, against deprivation score. In the final slide, you can see that these variations remain despite correcting for air pollution (left map) and (deprivation score) right map — in this case COPD

A person-centred approach to LTCs We have a growing population of people with long-term conditions and a growing number with multiple co-morbidities; On average someone with a long-term condition will spend 4 hours a year with a health or care professional, and 8,756 with their families and within their communities – yet the vast majority of health and care resource is focused on the professional interaction; Approaches that seek to build people’s capacity to manage their health and health condition(s) are key to meeting the needs of the population we have today, as well as addressing some of the economic challenges faced by the health and care system;

Continuing Health Care This is the most recent (March 2017) CHC supported population across GM per 10,000 population

Adult Social Care ASCOF 2B – The proportion of older people (aged 65 and over) who were still at home 91 days after discharge from hospital into reablement/rehabilitation services. Outcome measure highlighting the variance in effectiveness in keeping people out of readmission to hospital through reablement services.

Evidence and benefits of person and community centred approaches We know the health and care system is under considerable strain. We need to make it sustainable for the future. The answers will not come only by doing the same things we have always done. Many more answers can be found through a new relationship between services and citizens which: Enables people to live healthier lives through doing things differently themselves Supports people to better manage their conditions so they don’t need to use the health and care system as much Makes use of the help and potential in neighbourhoods which help people cope better, and stay independent longer There is now solid evidence person and community centred approaches reduce demand for health and care services as well as people telling us they make their lives and health better

Increasing complexity Who is it for and what kind of things will they get? People at End of Life, adults with a learning disability, and people with frailty/multiple long term conditions Better co-designed person and community centred support that improves peoples quality of life, reduces crises and the risk of them ending up in institutional settings 5% 140k 25% 700k 100% ~2.8m People with the highest need Proactive coordination of care that is person centred through multi-disciplinary teams including the voluntary sector Personal health budgets & integrated personal budgets People who are managing day to day long term conditions in their life: Proactive coordination of care and person centred care & support planning through neighbourhood teams alongside VCSE Self care support (including health coaching and self-management education) Community & asset based approaches The general population: Social prescribing Enabling Choice (e.g. in maternity and elective care) Asset based approaches People with long term conditions through neighbourhood teams Proactive approaches to supporting people to build knowledge, skills and confidence and helping them stay as well as they can Increasing complexity Whole population Universal approaches to supporting people to keep healthy, making informed choices and decisions at times of need

How will people experience this support?

What kind of support do we need?

Any questions?

For further detail go to: The End For further detail go to: www.gmhsc.org.uk @GM_HSC