Cautious optimism for new major health conditions strategy
Health leaders have welcomed a “long overdue” England-wide strategy for tackling six of the most common major medical conditions in the country, but say more detail – and haste – is needed.
Cancer, cardiovascular disease (CVD) including stroke and diabetes, musculoskeletal disorders (MSK), mental ill-health, dementia, and chronic respiratory disease (CPD), are responsible for more than 60% of ill health instances and early deaths in England.
According to the Department of Health and Social Care (DHSC)'s Major Conditions Strategy policy paper, published on 14 August, NHS England needs an overhaul in the way these six are approached.
In his foreword to the report, health and social care secretary Steve Barclay said the current system is “fractured” and difficult to manage.
Mr Barclay said: “We have heard how our citizens are not always empowered to live as healthily as they could, how people can find it difficult to navigate a fragmented system and that our present services are not always well placed to support people with more than one risk or condition.
“This means that support and care can be disjointed, waits are longer than they need to be, prescriptions interact unhelpfully and individuals living with long-term conditions can lack the ongoing help they need.”
The strategy lays out the need for joined up care between primary prevention (reducing risk of disease), secondary prevention (stopping conditions progressing), early diagnosis, prompt and urgent care, and long-term treatment and care.
Mr Barclay said primary prevention measures are the most effective, and suggested this would be a particular focus in the future.
“Almost everyone recognises that the hardest yards but biggest gains are found in primary prevention - and so we set out several things we want to do now, and several priority areas for ongoing development ahead of publishing the final strategy," he added.
The report highlighted the current difficulties for people who have more than one of the six major conditions.
Multimorbidity, Mr Barclay added, was significant source of confusion and leads to things being missed.
The report went on to state that this can led to slow diagnoses, complications for patients, and even some conditions being missed or treatments being under-explored.
It repeatedly iterated the need for investment in new research and technology to support faster diagnoses and lower waiting times, as well as a movement towards “opportunistic testing” in non-clinical settings for more anticipatory care.
Mr Barclay said: “We know that the needs of our population are changing rapidly and are fundamentally different from when the NHS was first created in 1948.
“Central to this is the rising incidence of multimorbidity. One in four of us are now living with at least two health conditions, and that proportion is expected to rise over time.
“Only by adapting our model of care to tackle this multimorbidity challenge can we ensure the NHS is still there for us in 75 years.”
The report laid out five key areas to be worked on which DHSC claimed would have the “greatest collective impact”.
The five priorities in the Major Conditions Strategy:
Rebalancing the health and care system, over time, towards a personalised approach to prevention through the management of risk factors
Embedding early diagnosis and treatment delivery in the community
Managing multiple conditions effectively - including embedding generalist and specialist skills within teams, organisations and individual clinicians
Seeking much closer alignment and integration between physical and mental health services
Shaping services and support around the lives of people, giving them greater choice and control where they need and want it and real clarity about their choices and next steps in their care
These five areas, the report stated, provide a “blueprint” for improving patient outcomes in the five major conditions.
Now this interim plan has been published, a new “phase” will begin where experts, people with lived experience, and other related organisations will be invited to work with DHSC to shape a full strategy with more specific detail on what will be done.
It also said the government and NHS will have to work together to actually enact the necessary changes: “Strategies alone will not change outcomes.
“Delivery will require concerted effort from the UK Government and the NHS working in tandem, alongside social care, patient representatives, industry and partners across the health and care system.
"It is a collective endeavour, but also a massive opportunity to preserve and protect good health for generations to come.”
Charities and leading health figures have welcomed the promise of an overhaul in the way major conditions are treated and prevented.
Teenager Cancer Trust chief executive Kate Collins welcomed, in particular, a pledge in the report to support faster diagnoses for young people.
“Teenagers and young adults with cancer have unique needs that differ from those of children and older adults, and require a specialist workforce with expertise as to how to meet them,” said Ms Collins.
“47% of teenagers and young adults diagnosed with cancer had to see their GP three or more times before referral – the most out of any age group.
“Cancer treatments can be less effective for young people as physical changes and rapid growth during puberty and young adulthood can negatively affect how the body metabolises chemotherapy, for example.
“And while clinical trials help researchers find new and better treatments, accessing them can be harder for young people as trials are not always designed with their needs in mind and sometimes have age limits which prevent young people from participating in them.”
Ms Collins said the full plan, whenever it emerges, “must be comprehensive”, and added: “Teenage Cancer Trust would welcome any opportunity to work with the government and the NHS to ensure the unique needs if young people are met.”
David Thomas, head of policy at Alzheimer’s Research UK, described the interim strategy as a “step in the right direction”, but said “rapid action” is needed for people waiting for delayed diagnoses for dementia, and those at risk of the condition.
Mr Thomas said: “Dementia is the nation’s biggest killer. One in two of us will be directly affected by it in our lifetime, either by caring for someone with the condition, developing it ourselves or both.
“Thanks to breakthroughs in research, we now have an unprecedented chance to change this outlook, and alleviate the pressure it places on our health and care system and society more widely.
“But this all depends on having a clear government strategy which sets out tangible actions to harness these research breakthroughs and ensure they deliver for everyone affected by dementia.
"Alzheimer’s Research UK is ready to hold government to account until this new strategy delivers just that.”
The report concluded by stating that in each priority area, DHSC will also work to reduce health inequalities as well as continue its existing health commitments.
These included working with the food industry to reduce sugar, salt and calories in food, contribute towards the Department for Levelling Up, Housing and Communities’ ‘levelling up’ schemes, and other preventive measures.
It also included more than a dozen commitments – and hundreds of millions of pounds, towards prevention, early intervention, diagnosis, and long-term care.
Health think tank Nuffield Trust’s senior policy analyst, Sally Gainsbury, also welcomed the report, and said the government was “right” to pick the six major conditions mentioned.
However, Ms Gainsbury said: “What’s less clear is how government will support health and care systems to do this in the context of severe pressures on staff and other resources, as well as a political culture that tends to place far more focus on what happens inside hospitals than what happens in community healthcare services, GP practices and pharmacies.
“This initiative is both long overdue and its emphasis has shifted over time: the Major Conditions Strategy is being developed in place of a white paper on Health Inequalities originally promised over 18 months ago.
“While the strategy’s six major conditions are also those conditions which form the immediate drivers of health inequalities in England, a perennial problem in healthcare - as with other public services - is that those who need help the most are often the least likely to access it.
“There is a risk that without more explicit emphasis on how the [strategy] can be used to tackle health inequalities – for example through focusing resources on deprived areas and tailoring services to excluded groups – life expectancy for those already well off will continue to increase, but there will be little or no reduction in the 19-year gap found between the most and least deprived neighbourhoods in England.”
Similarly, Danny Mortimer, deputy chief executive of NHS Confederation, said the strategy must “translate” into action to target comorbidities, as well as regional and demographic healthcare inequalities.
The report has absorbed previous independent strategies on mental health, something which Mr Mortimer said was something of a concern: “The government is stepping back from some of the ambitions it has previously set out.
“The cross-government strategy on mental health was, for example, also absorbed into this work and was critical to shifting the dial to focus on preventing mental ill-health and aimed to make services more sustainable in the future.
“Worryingly the government is currently only committed to providing mental health support teams in just over one in four schools. To fully assist children and to reduce regional inequality, healthcare leaders want to see a commitment from government to fund mental health support teams in all schools.”
He added that “joint working” will be what makes or breaks the strategy.