In England today 60 per cent of adults report a chronic health problem and 8.8 million have long term illness that severely limits their day to day ability to cope.Multiple long term conditions make care particularly complex, and a small number of patients and diseases account for a disproportionate amount of health care use (especially hospital care).

Matching the level of care to the level need calls for an approach which:

• Increases support for self care
• Strengthens usual primary care
• Offers responsive specialist care
• Manages vulnerable cases by anticipating their needs.

The different levels of need among people with long term conditions can be represented by the ‘Kaiser’ Pyramid of Care:

This shows that most (70-80 per cent) people with long term conditions can care for themselves, and need minimal input from health and social services.  They represent the bottom layer of the pyramid.

In the middle layer are ‘high risk patients’ – people who need more active disease and care management from professionals.

Finally, in the top level, are the patients with highly complex needs.These patients are usually aged over 65, and represent a tiny proportion of the population, but account for a large number of emergency admissions to hospital.

Much of the work that has been carried out in the management of long term conditions has concentrated on ‘case management’ for this third tier of patients.  Case management requires a key worker – often a nurse – actively managing and joining up care.

The Evercare and the Kaiser approaches, both originating in the USA, have been piloted in England.  However, the background to healthcare in the USA is very different because it does not have a National Health Service, and so it has been recognised that a model for management of long conditions that is specific to England needed to be developed.  The Department of Health has recently published this - click here to download.