Long term conditions framework: consultation analysis

9. Question 7

What services outside of medical care do you think are helpful in managing long term conditions? You may wish to comment on how these services prevent conditions from getting worse.

Introduction

The vast majority (92%) of respondents answered Question 7. The analysis identified three themes, including:

• theme 1: services outside of medical care identified as helpful in managing long term conditions
• theme 2: the important role and benefit of services outside of medical care
• theme 3: other issues raised

Theme 1: Services outside of medical care identified as helpful in managing long term conditions

The vast majority of individual and organisation respondents identified a wide range of services outside of medical care that are helpful in managing long term conditions. This aligns to theme 2 in this section which highlights the importance of providing holistic support to people with long term conditions that addresses the broader determinants of health (for example, welfare rights and financial advice services, employment advice, housing advice services).

These respondents frequently mentioned the important and valuable role of the workforce who provide services outside of medical care to people with long term conditions – for example, charities and third sector organisations, local authorities, specialist nurses/advanced nurse practitioners and allied health professionals (such as physiotherapists, occupational therapists, speech and language therapists, pharmacists and dietitians), community link workers and care coordinators.

Some organisations, including third sector organisations, advocated for the services outside of medical care that their own organisation provides. Individuals (people with lived experience of long term conditions) often mentioned the services they accessed and considered helpful and/or would like to have improved access to.

A consistent set of services outside of medical care were mentioned as helpful in these responses, including:

• social prescribing support and pathways – connecting people to activities, groups, and services in their community to meet the practical, social, and emotional needs that affect their health and wellbeing
• nutrition, physical activity, and behavioural and lifestyle services
• mental health, psychological, and psychosocial support
• self-management and education support
• peer mentoring and lived experience support
• social care and practical support for home care
• vocational rehabilitation – for example, physiotherapy and occupational therapy to support people manage daily activities, to get into work, and to prevent them from falling out of work due to health reasons
• other services mentioned included: speech and language therapy; employment, training, and volunteering opportunities; alternative therapies; and support for unpaid carers (for example, respite care, financial support)

Theme 2: The important role and benefit of non-medical care and support services

Many respondents (primarily organisations) mentioned the important role and benefit of non-medical care and support services including:

• integrated and holistic approaches that: connect medical and non-medical care across NHS and independent health and social care sectors; highlight the broader ecosystem of support beyond the medical model (including third sector, community based services, local authorities, unpaid carers, family members); and tackle health inequalities and address the broader determinants of health to help people with long term conditions make meaningful lifestyle changes to improve their overall quality of life
• benefits of services outside of medical care including to: support earlier intervention; improve management and education of symptoms and long term conditions; promote physical and mental health and wellbeing; foster social connections, provide emotional support, and to share experiences; reduce loneliness and social isolation through befriending and peer support; and reduce unplanned and emergency care and reduce hospital admissions

Respondents reiterated the challenges faced by organisations that provide non-medical care and services including: the historic under-recognised value/contribution of the third sector/ services outside of medical care in helping people to manage long term conditions; the role of the third sector in bridging gaps in public sector provision; funding challenges faced by these organisations and the need for sustainable longer-term funding; and workforce recruitment and retention challenges.

Respondent quotes that illustrate these points are presented below.

“Medical care alone cannot address the structural, emotional, and practical barriers many people face in managing long term conditions. Non-medical services are often the critical enablers that allow people with long-term conditions to manage their health effectively, maintain independence, and avoid crisis escalation.” Vantive

“While many people with long term conditions access social care services, care is predominantly provided by unpaid carers. Therefore any framework will need to recognise this and include actions to support the unpaid care workforce.” National Carer Organisations

“Social prescribing plays a vital role in the recovery model for individuals experiencing mental ill-health by promoting a holistic approach to wellbeing. Community Link Practitioners in General Practice are instrumental in connecting patients to these resources.” South Ayrshire Health and Social Care Partnership

Theme 3: Other issues raised

Some individual and organisation respondents identified other issues or considerations related to services outside of medical care for people with long term conditions. Most were recurring points raised at previous questions, and included:

• there would need to be a cultural change within health and care services to facilitate more people with long term conditions being supported to access services outside of medical care to help them manage their long term conditions – increased collaboration between the NHS and third sector
• there could be an increased focus on early detection, prevention, and early intervention services within the Long Term Conditions Framework
• there should be consistent and equitable access to services outside of medical care regardless of background, condition, or location
• barriers to accessing services outside of medical care need to be addressed – for example, cost and transport barriers
• services outside of medical care should be available close to home – and be available in a range of formats and settings
• improvements in the marketing, awareness raising and signposting of services outside of medical care among people with long term conditions
• further awareness raising and education on long term conditions within different settings, such as schools and workplaces, to strengthen prevention and support and to destigmatise the condition(s)
• stronger legislation, regulation and enforcement on harm causing environments, products and practices