Unhealthy absence: Chronic care remains missing in NHS discourse

Author: Clara Hilger, a second-year History and Politics student at University College. 

The NHS is the most politically embattled public service in the UK. It dominates election campaigns, carrying with it a highly personal rhetoric as each of the parties try to convince us that they will screw it up the least. Because they will all screw it up. And here is why.

Discourse surrounding the NHS almost exclusively focuses on ‘vital’ services. This piece of jargon covers all the services used to deal with acute conditions, and as a result includes GP practices, as well as Accident and Emergency Departments, NHS 111, and ‘out of hours’ practices. When politicians argue about the NHS, they do so in terms of the efficiency of A&E departments, emphasising closures, capacities and waiting times.

NHS management does the same. While working in the NHS, I was treated to daily ‘broadcast’ emails from the CEO of our hospital. These read as semi-political propaganda, attempting to convince us that we were, in fact, ‘all in this together’.  Naturally, the department of praise was A&E, the pinnacle of all NHS healthcare.

‘Congratulations to all those working in Accident and Emergency this week: we have seen a record number of 1500 patients. Thank you to all who made this happen.’

Down in the Eye Department, the other admin staff and I used to laugh. A&E had seen 1500 patients that week? We saw that many patients, if not more, every week. What’s more, we had waiting lists with thousands of people on them. But our patients are old, usually poor, and chronically ill.

Working in an outpatient clinic in a standard NHS trust made one thing very clear to me: chronic conditions, and those who suffer from them, are completely neglected in NHS policy.

The 2010 manifestos of the three main parties reveal a serious deficit in policy for chronic patients – those which have the most continued need for NHS services:

‘For people with a chronic illness or a long-term condition, we will provide access to a single budget that combines their health and social care funding, which they can tailor to their own needs’.

‘Everyone with a long-term condition, such as those with diabetes, will have the right to a care plan and an individual budget.’

Feel free to match these with their appropriate manifestos – it doesn’t really matter. One major party failed to mention long-term conditions altogether.

This neglect causes a financial problem. Acute care is cheap; it usually involves one consultation, one operation, one treatment. The upfront cost more or less ensures that an individual will be discharged from the NHS, unlikely to return in the foreseeable future.

Chronic conditions, including mental health conditions, are comparatively expensive. Patients who are diagnosed with chronic illness require regular treatment for the rest of their lives. Simply number of prescriptions that these patients need reveals how much more of the NHS budget needs to be spent on chronic care.  “But we pay for our prescriptions!” shout the sceptics.

Of course. Except that chronic conditions disproportionately affect those who are exempt from prescription charges: those over 65, and those with physical disabilities. In the year 2014-2015, the expected cost of prescriptions is over £1 billion.

This only takes into account the physical symptoms of long-term illness. Patients with chronic illness have to come to terms with the fact that they will never be ‘cured’, a psychological obstacle that often requires counselling (and therefore, a greater portion of the NHS budget). No wonder chronic services are struggling.

Their budgets do not need ring-fencing; they need increasing.

According to the King’s Fund, 15 million people in the UK are currently suffering with at least one chronic illness. That’s 1 in 4 – and this figure will only increase as the population continues to age. This aspect of the NHS, which constitutes a significant proportion of its use in society, deserves greater effort and time from policy makers.

We need to change how we discuss healthcare in this country, and the media need to lead the way. Until a deliberate distinction is made between chronic and acute care, we will continue to underfund and suffocate the NHS.

OxPolicy is a non-partisan think tank that reflects voices from all sides of the political discussion; the opinions within do not necessarily reflect the views of the OxPolicy as a whole. 

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  1. sarah

    As a young person in my 40s with a chronic condition for the last 15 years I agree.I have had continuous appointments in this time all messed up by maladministration and an attitude of staff who don’t know me assuming as I am a young outwardly normal person that I must be living a full normal life yet I am disabled because my chronic condition is well down the list of things for them to deal with and although things can be done I will be dead before that happens. Chronic disease patients should be put on a fast track for getting appointments and operations as we are already very hampered by our medical problem and spend too much of our life  around hospitals. Acute patients should NOT be who a health SERVICE is designed around. Medical television programmes are so misleading. Patient has suddden accident/crisis, sees consultant,has operation /treatment and they are cured and live happily ever after. That is not how it is for people like me who most need it.

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