Issue - meetings

To receive a presentation a presentation from Professor Sue Procter from City University, the Panel’s independent expert adviser, on:

·        General principles and policy issues

·        Evidence of what works best.

The Panel received a presentation from Professor Sue Procter, from the City University, on key issues relating to high intensity users and interventions that have undertaken.   

High intensity users tended to have one or more long term conditions (LTCs) plus complex social circumstances and/or additional mental health problems including anxiety and depression.  Not all patients with one or more LTCs became high intensity service users.  Those that did tended to make additional demands on A&E and out of hours services, including hospital admissions, and/or suffered from LTCs that had traditionally been managed by the NHS in isolation from social services (e.g. COPD, diabetes, heart failure). 

High intensity users could be managed as part of a strategic response to LTCs, but tended to require additional demand management strategies such as;

·        Anxiety management

·        Out of hours and fluctuating support from social services in response to exacerbations of their condition

·        Help to address complex social circumstances

·        Containment strategies in order to prevent the patient bypassing planned care system

The Chronic Care Model identified the essential elements of a health care system that encouraged high quality chronic disease care.  Strategic responses to high intensity were typically based on these.  These elements were:

·        Community resources and policies

·        Health care organisation prioritising chronic care

·        Self-management support

·        Delivery system design

·        Decision support for to ensure integration of protocols and guidelines

·        Clinical information such as

Ø      Reminder systems to support compliance

Ø      Feedback to health professionals providing information on chronic illness measures such as hypertension or lipid levels

Ø      Registries for planning individual patient care and conducting population based care.

The role of the Community Matron was an important part of many strategies.  Community Matrons typically took responsibility for about 50 older people with high levels needs and worked collaboratively with all professionals and care givers.  They worked in partnership with GPs and members of the primary health care team.  They worked with the patient to develop a personal care plan, kept in touch and regularly monitored the patient’s condition.  They performed a range of useful functions such as:

·        Initiating action as required

·        Updating medical records

·        Mobilising multi-agency resources as required

·        Educating care givers into when to alert services

·        Generating additional support as required

·        Maintaining responsibility for patient even if they are admitted to hospital

·        Preparing relatives and patients for health outcomes

·        Evaluating care packages with GP.

In respect of telemedicine, there was very little UK evidence so far.  Its implementation was still beset by technical problems.  It required a well maintained system of response and worked best when linked to telecare and call alarm systems.  An evaluation undertaken in NE London indicated that telemedicine aided communication between patients and health care professionals and could lead to the resolution of seemingly intractable problems.  However, it was not universally acceptable to all very high intensity users. In addition, patients and families already experiencing high levels of stress may not welcome additional stress when technical problems are experienced with telemedicine.

On the whole, UK information systems were not  ...  view the full minutes text for item 32