Long term conditions report – podcast transcript
1.	What’s this report about?

Our report looks at how services for people with long-term conditions are being managed across Scotland.
2.	What have you found?

We found that services for people with long-term conditions are improving but there is considerable progress to be made to provide cost-effective, community-based care.
−	One in five people in Scotland have a long-term condition such as diabetes, epilepsy or chronic bronchitis.
−	Care for people with long-term conditions is getting better but more needs to be done. The NHS and councils need to join up services so that people can receive better care.
−	As the population ages we will have to spend more on providing care for people with long-term conditions. For the NHS and councils to plan for this properly they will need to know how much that will cost but this information is not currently available.
−	People with long-term conditions want to do more to manage their own conditions and the NHS and councils need to help them to do this. For example, by providing more information about their conditions at when they are diagnosed and information on all the services available to them from the NHS, councils and voluntary organisations.
3.	What has been the impact on patients and care?

People with more than one long-term condition are less likely to be receiving joined-up care across all the services they receive. Patients want better information about their long-term conditions and many want a greater involvement in their own care.
Examples of how care could improve for patients include:
•	Providing more community-based services: What this means for someone with emphysema is that most services should be provided in local health centres or community hospitals and there will be less need to travel to hospitals for specialist care. Also, care should also be more timely.
•	Better patient information systems: For someone with epilepsy, whether they are visiting their GP, attending a clinic in hospital or receiving social care, the professional providing their care would be able to access all the relevant information about their condition and provide the most appropriate care.
•	Self care: People we spoke to with long-term conditions are keen to take more responsibility for their own care. They feel they know their condition best and with the right information and support can look after themselves most of the time. This can increase their confidence, make them feel more in control and means they are more likely to only seek help when they really need to.
•	Joining up health & council services: As the number of people with long-term conditions increases and more care is being provided in the community, the NHS and councils will need to work together better to ensure that people’s health and social care needs are met. The NHS and councils will need to be more proactive and creative in the way they provide services, for example with some additional training social care staff could address the wider health needs of people with long-term-conditions.
4.	You say care is improving. Where has it improved?
In recent years the community-based management of diabetes and asthma has generally improved. This is partly because these conditions are among the most common in Scotland. It is also because they are more straight-forward to manage in the community than other conditions, and thus it is easier to set up effective services. 
Those two conditions aside, there are no particular areas in which there has been uniform improvement across Scotland. There have been many improvements in vastly different clinical areas in different places across Scotland and these are usually local projects, driven by a local need or enthusiasm rather than by a national strategy. The Scottish Executive, health boards and councils need to do more to make improvements nation-wide and to create joined-up services.
5.	How do prevalence rates in Scotland compare with the rest of the UK? With Europe?
The estimated prevalence rates in Scotland of 1.9% for COPD (95,042 people) and 0.7% for epilepsy (35,417) are similar to those in the rest of the UK; prevalence is higher in older age groups and more deprived areas.
For COPD, studies have estimated the prevalence rate in Europe to be between 4% and 10%, and for epilepsy, between 0.4% and 0.8%. Estimates can vary depending on the methods used.

6.	What do you want to see happen as a result of your report?

We would like to see:
•	better information collected on activity, cost and quality of services for long-term conditions by the NHS and councils.
•	more evaluation of different ways of providing services to ensure cost-effectiveness and the sharing of good practice.
•	better working between CHPs and the acute sector to support the development of community services.
•	development and implementation nationally of a single electronic patient record to assess and manage the total care package for each individual.
•	targets to support the development of community based services.
•	more guidance and support from the Scottish Executive for boards and councils on how to develop shared business plans for resource transfer to facilitate shifting the balance of care.
•	comprehensive information provided to patients about their condition, and the health and social care services available, at the time of diagnosis.