Long-term approach to long-term conditions

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In March this year the UK Department of Health published the National Service Framework (NSF) for Long-term Conditions (www.dh.gov.uk/longtermnsf). As with all such seed change, language and labelling are of essence with the subtle but significant use of ‘long-term’ rather than ‘chronic’ as a descriptor. ‘Chronic’ tends to carry more negative connotations than ‘long-term’.

This NSF sets 11 quality requirements to transform the support of people with neurological conditions. It importantly points out that although the NSF focuses on long-term neurological conditions much of the guidance it offers can apply to anyone living with long-term conditions such as arthritis. It marks a real change in the way health and social care bodies and their local partners will work with people with long-term conditions to plan and deliver the services which they need to make their lives better, the NSF demonstrates the importance of the person-centred approach for everyone who uses health and social care services. It values improving access to assistive technology and opening up palliative care for people with neurological conditions and can also apply to other people living with disabilities and persistent pain. It aims to improve peoples’ lives by:

The heart of the framework are the 11 quality requirements which can be applied across all areas of long-term conditions in orthopaedics:

The above are an abridged and modified version of the quality requirements but the clarity of thought and intention are obvious. Many orthopaedic nurses would feel that it is about time attention was focused on this large and invisible sector of health care users even if it identifies a very specific group of those with neurological conditions the ‘knock-on’ effect for those with long-term orthopaedic conditions is implicit.

But does it meet the four ‘Es’? The built in quality requirements would hopefully ensure ‘effectiveness’ and the ‘ethics’ of providing essential services as a right for a large number of people suffering from long-term conditions satisfies the elements for beneficence. ‘Efficiency’ and ‘economy’ will prove a little more difficult in a health service that is used to responding in a manner of short-term acute intervention. The quick short-term intervention to keep things going without addressing underlying fundamental problems is often the current approach of choice in the NHS. The NSF marks a change in this philosophy. Often, in future, a small scale but prompt and appropriate response by health care professionals will prevent people with long-term conditions deteriorating and unnecessarily suffering until a large scale expensive and inefficient intervention, such as hospital admission, is necessary. This has to be the way forward in orthopaedics and, if current UK patterns of service improvement are pursued, will be led by specialist orthopaedic nurses working in close collaboration with our health care professional colleagues. Are we ready?