This week's news that the UK is slipping down the European health league table yet again highlights the need for strategies to tackle and manage preventable long term conditions and smoking-related illnesses, such as lung and heart disease and cancer.
It has been estimated that by 2018, nearly three million people will suffer with three or more conditions at once. This will have a significant impact on the health service, both in terms of cost and the ability to deliver quality care. Additionally, the impact on the patient will be even more critical. Patients are already becoming disengaged from their care and are forced to endure unnecessary hospital treatment, or sustained unemployment, because their condition has not been managed optimally.
Tomorrow’s healthcare model must optimise technology, harness the power of information and share it across the health and social care system in ways that join up care, connect organisations and empower patients. Moreover, if the NHS is to deliver patient-centric services built upon the principle of "no decisions about me, without me" – and in the process, facilitate more effective management of chronic disease – the integrated use of innovations such as telehealth and health coaching must become the rule rather than exception.
The recently-published NHS Mandate outlines an NHS Commissioning Board objective to drive a substantial increase in the use of technology to help people manage their health and care. It encourages Clinical Commissioning Groups (CCGs), providers and local councils to collaborate to overcome the practical barriers that prevent services working together effectively – and in particular, challenges local commissioners to stimulate the development of innovative, integrated service provision across primary, secondary and social care.
The Mandate promises to make "significant progress" in helping patients with LTCs to benefit from telehealth and telecare, enabling them to manage and monitor their conditions at home – reducing avoidable hospital admissions and improving health outcomes.
With the emergence of a new NHS commissioning landscape just around the corner, CCGs and Local Authorities must indeed work in partnership to ensure that local health and social care budgets are not eroded by the inefficient management of long-term conditions. The most proactive will take advantage of innovative technologies that already exist.
The UK needs to embrace strategies such as telehealth and health coaching as part of a holistic, integrated care system, in order to improve its performance and the overall health of our nation. These strategies are already having a profound effect on the management of long-term conditions.
Health coaching, where specially trained nurses support and mentor patients in partnership with local health organisations, can make a huge difference to individuals diagnosed with long-term conditions by addressing key concerns about their condition via two-way phone calls. This technique is emerging as a powerful platform to nurture informed patients, help them change unhelpful thinking patterns and proactively manage their disease.
Crucially, health coaching programmes are conducted in partnership with local health organisations, ensuring that doctors maintain total control of the patient relationship. Coaches can talk to patients, using the correct, non-directive, terminology and suggest whether they need to report symptoms to their GP which crucially may provide the necessary spur a patient requires to help early diagnosis, prevent an unplanned emergency admission and improve health outcomes.
The information the nurses take in through health coaching plus any data that arrives through telehealth monitoring can also be entered into an integrated system so the health coach is alerted to anything that looks out of range and send a notification securely to the relevant GP or hospital consultant who is linked to the patient, enhancing the support and care for the patient yet further.
The approach has been shown to increase patients’ confidence and skills in self-management, and help them prepare for consultations, proactively consider treatment options and encourage them to change their behaviour. There has been a lot of news of late about patients not wanting to bother their GP and as a result, going to their doctor too late. This is where health coaching can also help as it provides a valuable alternative and an opportunity for patients to discuss the longer-term management and implications of their condition – and proactively manage it – without the time pressure during a doctor’s appointment.
At a national level, online help to assist shared decision-making between patients and doctors is being started and is, at present, providing patients with vital information to help them manage their illness. Combined with health coaching, this is helping to bring about a change in behaviour, health benefits and cost savings for the NHS.
Building a new model for the management of long-term conditions is not impossible – it’s already happening. And it works. It just requires some innovative thinking.
Wendy Lawrence is CEO of Totally Health
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