Health complexity

Long term conditions

A constructive enquiry into the South West Peninsula Strategic Health Authority's work in delivering the Long Term Conditions Agenda

Improving care for people with Long Term Conditions (LTC) has risen up the political agenda. A number of political and policy drivers have ensured that this agenda has been in large part, 'driven from the top'. However in many ways, this agenda is also 'bottom up'; there is seen to be a need at a local level to reduce the burden on people with long term conditions, a need to reduce inequalities, and a need to encourage the effective use of healthcare resources. In addition, some argue that there is good alignment of patient need, clinical motivation and financial virtues in delivering this agenda.

The South West Peninsula Strategic Health Authority's (SWPSHA) move towards focusing on the LTC agenda occurs as the relation between Strategic Health Authorities (SHAs) and Department of Health (DH) organisations working on service improvement and innovation enters a period of reconfiguration. Prompted by the Arms Length Bodies Review , and based on feedback collected from SHAs, a new Institute for Learning, Skills and Innovation (temporarily known as the NHS Institute) will replace the Modernisation Agency (MA) and the National Health Service University (NHSU) on the 1st of April 2005. The strategic vision articulated by the DH on behalf of this new organisation entails the development of networks of innovation and knowledge, which enable the creation of new methodologies for service improvement alongside a responsiveness to the local needs of healthcare organisations. With this new framework, the role of SHAs becomes crucial. They will function as the connectors of the centre, represented by the NHS Institute, with its national priorities, and the local; they will enable the identification of local needs, and the communication of these needs to the NHS Institute, while at the same time, facilitating the most effective networks to be established with the NHS Institute to ensure that local needs are responded to successfully. It is within this context that the SHA will be seeking to determine its precise role in working towards the local delivery of the LTC agenda.

This study, commissioned by the SWPSHA, will focus on the SHA (the 'intermediate' layer) in terms of its delivery of the LTC agenda, as well as reflecting on where the SHA gets its ideas (the 'triggers') and on how PCTs and individual practices translate these ideas. This study has the following aims:

  • To determine if the SWPSHA has a role in helping to deliver the LTC agenda, and if it has, to identify what that role is,
  • To determine the strategic vision regarding the delivery of care for people with long term conditions and on how the agenda can be met,
  • To explore how the strategic vision is implemented across the SWPSHA,
  • To determine where the LTC strategy resides within the SWPSHA, how it has been developed, and whether or not PCTs have ownership of the strategy and strategic vision,
  • To explore how the SWPSHA communicates this LTC programme of work to its stakeholders and how it is perceived by and operates within, its stakeholder organisations,
  • To reflect on any new operational relationships that have been formed as a result of this strategic vision and this new way of working,
  • To determine the extent to which the SWPSHA's programme of work is being successful in delivering the LTC agenda.