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Better planning needed for chronic conditions services

04/12/2008

Auditor General calls on Welsh NHS to take action

The NHS in Wales is not providing services that fully support the effective management of adults with a chronic condition, says a report by the Auditor General for Wales.

One-third of the adult population in Wales, an estimated 800,000 people, report having at least one chronic condition, such as diabetes, bronchitis or heart disease, with 13 per cent of these adults reporting two or more conditions. These rates are higher in Wales than the rest of the United Kingdom. Chronic conditions place a considerable demand on healthcare services, accounting for 80 per cent of all GP consultations. The report found that too many patients with chronic conditions were treated in an unplanned way in acute hospitals while the large numbers of community services were poorly coordinated and insufficiently integrated, leading to an inconsistent service for patients.

The Welsh Assembly Government has been active in promoting a change of emphasis from treating patients with chronic conditions in hospital to preventing conditions arising, and where possible providing services in or close to the individual's home. The Assembly Government has continued to encourage improvement, publishing a strategic framework for Chronic Conditions Management in 2007 and an associated service improvement plan in January 2008. The Assembly Government has also provided an additional £15 million over the next three years to support chronic conditions management and community based models of care.

However, the report highlights the pressure faced by acute hospitals with chronic conditions accounting for at least one in six of all emergency medical admissions.  The number of emergency medical admissions for chronic conditions has increased in some trusts, suggesting limited alternatives to admission to hospital.  The report also sets out areas of weakness in how community services were run. The primary purpose of such services was to prevent admissions to hospital or to facilitate early discharge, but two-thirds of these services were available on weekdays only, even though more than half of the admissions to hospital were outside these hours.  Planning of services for people with chronic conditions was undermined by a lack of consistent assessment of local population health needs, the likely demand for services and the extent to which services currently provided would meet those needs and demands.

The report makes a number of recommendations for improvement, including:

  • Incorporating community-based intermediate care and chronic condition services into core NHS delivery and models of care;
  • Making all relevant staff across partner organisations aware of what services are available in the community and how to access them;
  • Taking account of the flow of patients across health community and unitary authority based services when planning services; and
  • Proactively engaging patients and local communities in the planning of services.

Auditor General for Wales, Jeremy Colman, said today:
"Chronic conditions are placing a huge demand on the NHS in Wales, in particular the hospital sector, which is not sustainable in the longer term. There are inconsistencies in the services on offer within the community and this report makes a number of recommendations on how these should be addressed. The Welsh Assembly Government has demonstrated a commitment to improvement in developing its strategy for the management of chronic conditions, but further work is needed.

Notes to Editors:

  • This report outlines key conclusions drawn from a WAO audit undertaken in 2006 and 2007 across 12 NHS Trusts that provide acute and community healthcare services and the 22 local health boards that either commissioned them or in some cases directly provided them.
  • The Assembly Governments approach to chronic conditions management can be found in a number of key documents including:
  • The Wales Audit Office is independent of government and is responsible for the annual audit of some £19 billion of annual public expenditure. Its mission is to promote improvement, so that people in Wales benefit from accountable, well-managed public services that offer the best possible value for money. It is also committed to identify and spreading good practice across the Welsh public sector.
  • The Wales Audit Office was created in April 2005 through the Public Audit (Wales) Act, 2004, which expanded the functions of the Auditor General for Wales and enabled the transfer of staffs from the Audit Commission in Wales and National Audit Office in Wales to his employment.

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