How realistic is the Government’s integrated approach to major conditions?

Seb Phillips

Senior Account Manager

In an era marked by intricate health challenges, the Department of Health and Social Care (DHSC) is looking to its upcoming Major Conditions Strategy as the paradigm shift necessary to transform how the Government and NHS England approach the delivery of care.

Breaking free from the confines of single disease strategies, the DHSC hopes the Major Conditions Strategy can help shift the way decision-making is prioritised and pave the way for integrated, personalised care that transcends traditional departmental and healthcare boundaries.

Announced in January 2023, the Major Conditions Strategy is a blueprint that recognises the limitations of conventional single disease strategies. While such strategies have undoubtedly yielded significant advancements in specific fields, they can often fall short in addressing broader contexts of a patient’s health and wellbeing, with one in four people now living with at least two health conditions.

For industry or patient stakeholders, this shift must be acknowledged and reflected in engagement strategies, with an assumption that any calls for a single-disease approach will now largely go unheard.

Covering cancer, heart disease, musculoskeletal disorders, mental ill-health, dementia and respiratory diseases, conditions that account for over 60% of ill health and early death in England, this new approach seeks to rectify shortfalls by embracing a cross-departmental approach on health prevention and treatment, acknowledging the intricate interplay of various health and wellbeing factors.

While a policy of the DHSC, funding and programme commitments for the Strategy are also coming from departments the Government sees as vital in shaping the environment in which people make choices, namely the Department for Education, Department for Culture, Media and Sport and Department for Levelling Up, Housing and Communities.

Aiding the strategic approach is the recent transition from NHS England’s Clinical Commissioning Groups (CCGs) to Integrated Care Systems (ICSs). ICSs are intended to foster collaboration among different healthcare providers, local authorities, and communities to streamline care pathways and enhance patient experiences. The synergy between the DHSC’s Major Conditions Strategy and the ICS framework is therefore evident, as both emphasise the need for a holistic, integrated and patient-centric healthcare.

However, with this approach, the successful implementation of the Major Conditions Strategy largely hinges on the ability of NHS England to effectively establish ICSs and the ability for Government to truly work cross-departmentally.

ICSs are the backbone of integrated care, facilitating the coordination of various healthcare elements to offer comprehensive, tailored solutions. So, their effective integration is without a doubt a pivotal precursor to realising the ambitious goals of the Strategy. Similarly, ambitious, effective and cooperative operations between four large Government Departments is vital.

However, this reliance on successful integration and cross-departmental working is an issue, as neither are currently common practice. While showing signs of success, many feel ICSs are too varied in how they operate, currently ranging from fully integrated healthcare bodies to glorified funding pots with no true oversight of integration or personalisation.

The Major Conditions Strategy is a forward-looking initiative that holds the promise of redefining healthcare. Its departure from isolated approaches in favour of integrated and personalised care is a bold step towards comprehensive and holistic health management.

Therefore, the successful establishment of cohesive systems across NHS England and Government is of paramount importance. These systems will serve as the fertile ground for innovative care models to flourish, enabling healthcare providers to deliver the right care, at the right time, and in the right place.

One aspect of the Strategy’s approach that is entirely reliant on these dreams becoming a reality is the integration of technology into healthcare. Technological advancements have revolutionised the way we diagnose, treat, and manage major conditions, and have the potential to enhance healthcare efficiency and outcomes. However, the current scenario across NHS England and Government is marked by considerable variation in the quality and availability of such technologies.

This variation is largely due to failures in the aspects needed for the success of the Major Conditions Strategy, integration and inter-governmental operations, with a technology pathway mangled between 4 to 5 Government bodies and 42 ICSs, all seemingly speaking different languages.

As we look to the future of healthcare in the UK, the Major Conditions Strategy, coupled with robust Integrated Care Systems holds the key to a more holistic, patient-centered, and technologically advanced healthcare landscape. By embracing this transformation, we embark on a journey toward better health outcomes and improved quality of life for all. However, previous lessons must be learnt, with effective implementation strategies assured for the strategy, including proper frameworks for effective integration and productive cross-departmental working.

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