Steve How and Oli Hudson, of Wilmington Healthcare, explore the NHS Long-term Plan’s strategy for delivering more preventative, joined-up services for major health conditions
The Long-term Plan furthers the NHS Five Year Forward View’s focus on cancer, mental health, diabetes, multimorbidity and healthy ageing. It also looks at other areas, such as cardiovascular and respiratory conditions, and explains how the NHS plans to change its approach in order to drive improvements in patient care and outcomes.
Cardiovascular disease (CVD)
Cardiovascular disease (CVD) has been identified in the Long-term Plan as “the single biggest area where the NHS can save lives over the next 10 years”. Detecting patients at risk of CVD and preventing the disease from occurring will be key to helping the NHS achieve its ambition.
In line with this, pharmacists and nurses in Primary Care Networks (PCNs) will be supported in identifying and treating relevant cohorts of patients. There will be a big focus on lifestyle improvements for at-risk patients, particularly weight management, as well as social prescribing. A new national CVD prevention audit will feed into the above activities.
There will also be a major structural change in stroke services, where hyper acute specialist stroke centres with new clot busting technology will be replacing existing stroke-receiving units.
The NHS plans to double the size of the NHS Diabetes Prevention Programme for type 2 diabetes. As with other disease areas, there will be a big emphasis on engaging patients in managing their health and also on disease prevention. Aligned with this weight management services will be critical, particularly in light of recent studies which have shown that if patients lose weight rapidly and significantly, it is possible to go into remission for type 2 diabetes.
The Long-term Plan shows how technology will help to move diabetes services out of hospitals and support self-care. For example, newly diagnosed patients will be offered expanding provision of structured education and digital self-management support tools including HeLP Diabetes – an online self-management tool for those with type 2 diabetes.
The NHS aims to increase the number of cancer diagnoses at stage one and two from 50 percent of patients now to 75 percent by 2028. Changes will include modernising the Bowel Cancer Screening Programme and making the Faecal Immunochemical Test for haemoglobin easier for patients to use. The NHS will also implement HPV primary screening for cervical cancer across England by 2020.
The NHS plans to introduce a new faster diagnosis standard from 2020 to ensure that most patients receive a definitive diagnosis or ruling out of cancer within 28 days of referral from a GP or from screening.
The new diagnosis standard will be underpinned by a radical overhaul of the way diagnostic services are delivered for patients with suspected cancer. Starting this year, new Rapid Diagnostic Centres (RDCs) will be rolled out across the country to upgrade and bring together the latest diagnostic equipment and expertise. Cancer Alliances will also work with Integrated Care Systems (ICSs) to aid swift access to a consultant’s opinion.
The NHS will build on the existing NHS RightCare programme to reduce variation across the country in the quality of spirometry testing, which is a key test for lung function. PCNs will support the diagnosis of respiratory conditions; while more staff in primary care will be trained and accredited to interpret test results.
Pulmonary rehabilitation, which involves activities such as breathing exercises and learning how to cope in an emergency, is one of the most expensive elements of the respiratory pathway. It will be run by multi-disciplinary teams using digital tools, such as My COPD, which is a toolkit for Clinical Commissioning Groups (CCGs).
Pharmacists will play a big role in managing respiratory care in PCNs. This will include medication reviews, educating patients and also advising on the use of inhalers – a critical task given that 90 percent of people use their inhaler incorrectly, according to the NHS.
In the Long-term Plan, the NHS makes a new commitment to funding mental health services for children and young people, and pledges that this area will grow faster than both overall NHS funding and total mental health spending.
There is also a realisation that children’s mental health goes beyond the NHS; hence we expect to see multidisciplinary teams working in schools as the first point of contact for pupils.
The NHS promises to continue to expand access to IAPT services for adults and older adults with common mental health problems, with a focus on those with long-term conditions.
Digital services, such as mobile apps, are expected to play a big part in delivery and access to mental healthcare services, especially for children and young people.
While the detail varies in each health condition, there are many common themes, particularly with regards to illness prevention and the associated need to risk stratify patients; engage them in their treatment and encourage them to make lifestyle changes, where appropriate.
There is also a desire to deliver many services for these conditions in the community via integrated teams in PCNs. Consequently, it will be essential for pharma to think about how its products can deliver benefits across the whole care system and to determine how it can support the NHS in delivering more holistic, preventative care services.