Long term thinking

With the pandemic absorbing health resources, patients with Long-Term Conditions are continuing to suffer delays in diagnoses and treatment. So how can we make sure the needs of these patients are put at the heart of the NHS Recovery? We speak to two MPs with personal experience

Since the summer of 2021, the Prime Minister has repeatedly made it clear that the UK needs to “learn to live with COVID.”

This is a recognition that the current pandemic is not necessarily a time-limited event that can easily be consigned to the history books. Instead, it is an ongoing health challenge that all of our lives will have to adapt to accommodate.

What it also means is that we must move on from the idea that major public services such as the NHS will simply “return to normal” once the pandemic passes. Instead, we will need to redefine what “normal” actually means within a post-pandemic world. New ways of working and new models of service delivery will need to be developed that build on the innovation we have seen during the last two years.

One of the most pressing issues that these new models of delivery will have to tackle will be addressing the backlog of treatments which COVID caused for the 15 million Britons who currently suffer from a LongTerm Condition.

As COVID has understandably absorbed attention and resources, this group has suffered more than most, with delays to both diagnosis and treatment. A recent report by leading healthcare consultancy Carnall Farrar, suggests that across six disease areas there are now an estimated 124,000 patients in the UK missing from the health system due to missed or late diagnoses resulting from COVID. Vicky Foxcroft, Labour MP for Lewisham and Deptford and the Shadow Minister for Disabled People, herself lives with a long-term condition. In 2019 she was diagnosed with rheumatoid arthritis, a condition that affects over 400,000 people in the UK. Meeting the needs of people living with long-term conditions is a subject that she cares about passionately.

“Supported self-management is more important than ever before – helping people to stay well, set their own goals, measure their own health.” Tom Randall MP

“I have been contacted by many people with rheumatoid arthritis who have struggled to get appointments over the last 18 months,” she tells Dods. “This is in part due to the fact that some specialists have been redeployed to work on Covid-19 therapies. Whilst this is of course understandable, early treatment is important in improving long term outcomes and undoubtedly some people have suffered as a result of delays.”

Conservative MP Tom Randall, who has spoken in the Chamber about his experience living with Axial Spondyloarthritis – a chronic inflammation of the spine and joints – echoes Foxcroft’s concerns about the impact of the pandemic on treatment for longterm conditions. “Covid has undoubtedly exacerbated the situation,” he tells us. “Patients have been unable to get rheumatology appointments and calls to the helpline of the National Axial Spondyloarthritis Society have increased by 50% over the last 2 years.”

He adds: “Diagnostic delay is the most pressing concern in axial SpA…With an average age of symptom onset of just 24, a delayed diagnosis robs young people of opportunities to socialise, start careers and form relationships.”

Todd Manning, General Manager at pharmaceutical research and development specialists AbbVie UK, tells us: “Finding new ways to deliver better outcomes for people with Long-Term Conditions absolutely has to be a key building block for the NHS Restart.

“People with Long-Term Conditions make up a staggering 50% of NHS appointments and occupy 70% of hospital bed capacity. Quite simply, there is no credible NHS recovery plan that does not include new, flexible, and modern ways to deliver health support to these groups.”

It is this need for innovation in delivery which is now at the forefront of health discussions in the UK. COVID has been a profoundly disruptive event, but as with all disruptive events it has also helped stimulate new approaches to deal with old problems.

For instance, as a direct result of COVID, we have seen widespread digitalisation of services, a growing appreciation of selfcare pathways, and an increasing focus on drug treatments that can be used outside of hospital settings. These are all lessons that can now help shape new, modern approaches to help the NHS meet the challenge presented by the growing number of people who are living with Long-Term Conditions.

Key to achieving this will be effective collaborations between the public and private sectors.

“If the pandemic response has taught us one thing,” says Manning, “it is that innovative solutions can be put in place very rapidly when government bodies work hand-in-hand with the UK’s world-leading biotech and pharmaceutical sectors.”

Abbvie believe that this model of crosssector collaboration can now provide a template for the emergence of new partnerships to help create a modern, effective, and well-resourced health service, flexible enough to meet the growing needs of people with long-term conditions.

Randall adds: “It may take some time for the healthcare system to recover from Covid and so in this context supported self-management becomes more important than ever before – helping people to stay well, set their own goals, measure their own health. Technology has an important role to play in helping patients do this and helping them stay in touch with their clinicians who can monitor them.”

While face to face care is more appropriate for many patients, some older patients who are less physically able and those managing their conditions “may find virtual appointments significantly easier compared to attending hospital in-person”, Randall says.

Foxcroft agrees that any new approach must reflect the different health needs of individual patients. “While online and telephone consultations work for some,” she tells us, “for others it can mean missed diagnosis of serious illness. We need to find a balance where there is the option for everyone to access services in the way that is most appropriate to them.”

If “learning to live with COVID” is to be more than just an empty slogan, then providing a wide range of options for people living with long-term conditions is a challenge that demands a whole system approach. It is, quite simply, a challenge too big for any one organisation or sector to seek to tackle alone.

“Highly effective medicines, used early in the pathway, are critical, but on their own can only ever be part of the solution,” Manning tells Dods. “That is why, as a company, AbbVie is also committed to working in partnership with the NHS to redesign service pathways reducing pressure on the system and allowing patients to self-manage their conditions. This is better for the NHS, but most importantly it is better for those patients and their families.”