New guidelines issued to help improve quality of life for older people with multiple long-term conditions

The latest guidelines published by the National Institute for Health and Care Excellence (NICE) have called for health and social care services to work together to ensure that people with multiple long-term health conditions are involved in planning their own care.

The guidelines focus on the group of people most likely to have several long-term health conditions – older people. They include recommendations specifically to ensure that care plans are developed in collaboration with care providers and GPs, as well as community pharmacists, physiotherapists and mental health workers.

Deputy chief executive for NICE, Professor Gillian Leng, said: “It’s estimated that as many as 6 million people in England aged 60 and over are living with more than one long-term health condition.

“As the number of older people in society increases, the number living with long-term conditions will also rise. A recent report by Age UK noted that a further one million older people in England could be living with multiple long-term conditions by 2020. This will inevitably put pressure on health and social care services and our new guideline highlights ways to best address the growing care needs of this group.”

Long-term conditions are those that last a year or longer, or those that can affect a person’s life, such as: diabetes, arthritis, mental health conditions and cancer. They may or may not require a person to take medication to manage their conditions.

Health and social care services should work closely to deliver safe and effective care

Millions of people in England are living with more than one chronic health condition, while thousands more could develop multiple long-term health conditions in the future. The NICE guidelines have been published to ensure care for these people remains high-quality and safe.

The guidelines call for health and social care services to work closely to ensure safe and effective care is delivered to the people they support.

Previous reports have indicated that health and social care services for older people can be disjointed or difficult to access. These latest guidelines aim to help services from the health and care sectors to find more effective ways of supporting older people with long-term health conditions.

Liverpool-based independent consultant in social care, health and management, Bernard Walker, chaired the NICE committee which developed the guidelines. He commented: “When social care and health practitioners work together well, it helps both people using services and their carers to have choice and control over their care. It also avoids unnecessary duplication of services.

“As a committee, which brought together a knowledgeable group of experts including practitioners, carers and people who use services, we recognised how critically important this issue is. Better integration of health and social care services is best practice to which everyone involved in the care of older people with complex care needs and multiple long-term conditions should aspire.”

The guidelines make recommendations for people who manage, commission and provide care for people with social care needs and multiple long-term conditions.

These include ensuring that person-centred care is being delivered and that each individual is being supported in a way that is respectful and promotes dignity and trust. In addition they recommend having a single named care co-ordinator for older people with social care needs and multiple long-term conditions.

Care plans should be developed in collaboration with GPs and representatives from other agencies that are providing sport to the older people in question, while making sure that there is community-based multidisciplinary support available from a team that could include a community pharmacist, physiotherapist and mental health worker.

Finally the recommendations state that older people with multiple long-term conditions and social care needs should be supported to maintain links with their family, friends and local community.

The guidance has been developed following consultation with several organisations, including Sense and includes recommendations relating to sensory loss.

Deputy head of public policy at Sense, Kate Fitch, said: “We know that 69 per cent of those reporting a dual sensory loss have two or more additional long-term conditions and only 64 per cent of people who have a dual sensory loss feel confident in managing their own health. We are therefore pleased to see several specific references to sensory loss including a focus on ensuring practitioners are able to recognise sensory loss, consider the impact and respond to it.

“Sensory loss can have a huge impact on the way an individual receives and experiences care and support. It can affect an individual’s ability to communicate and access information which, if not taken into consideration, can pose additional challenges to the way an individual understands, lives with and manages their other long-term conditions.

“With an increasing population of older people with hearing and sight loss, we welcome the guidance which will ensure sensory needs are recognised and considered when care planning for older people with long-term health conditions."

'Long-term conditions should be recognised and considered when planning care'

The NICE guidelines make specific recommendations for care homes, including: making sure people have a choice of things to eat and drink during the day which meet their nutritional needs and that they are physically comfortable; and building links with local communities to encourage interactions between residents and local people of all ages and backgrounds.

Furthermore, it supports the training of health and social care practitioners to allow them to develop the right skills and knowledge to help them do their jobs well.

The latest research conducted by Alzheimer’s Society reveals that three quarters of people living with dementia also have another long-term health condition. There are around 850,000 people in the UK living with dementia, and 70 per cent of those living in care homes have dementia or severe memory problems.

Director of policy at Alzheimer’s Society, George McNamara, said: “The current system doesn’t work for an ageing population and must urgently change. In the UK alone, by 2020 there will be more than seven million people aged over 60 living with more than one long-term condition. The fragmented nature of health and social care means that it is far too easy, and common, for vulnerable people to fall between the cracks.

“Dementia is one of the leading causes of disability later in life, and one that has a significant impact on how other health conditions are managed. We hope that this new guidance will help us to move towards one system that works for people living with dementia and their carers.”

Dr Andrew Williams from the British Geriatrics Society, said: “This is important and timely new guidance. With increasing numbers of older people living with multiple long term conditions, it’s increasingly important that social care providers are able to recognise long-term conditions, and consider their impact when planning an individual’s care needs. Careful care planning and care coordination is key to delivering true patient-centred care.”

To read the guidance, visit: http://www.nice.org.uk/guidance/ng22