"Increasing sub specialism & the decline of generalism..... can create a lack of co-ordination & oversight of patients multiple needs".
"Co-morbid mental health problems are particularly common among people with long term conditions".
"Supporting the psychological & mental health needs of people with long term conditions ...can lead to improvements in both mental & physical health. Existing provision fails to realise these opportunities. A separation of mental & physical health is hard wired into institutional arrangements, payment systems & professional training curricula".
"Physical illness makes the detection of mental health problems more difficult. The majority of depression among (this group) goes undetected & untreated (because of a) focus on physical symptoms".
"There are currently significant practical barriers that impede the effectiveness of liaison teams (often because they are) employed by a mental health trust, but working in a hospital run by an acute trust. Communication & co-ordination can be compromised by IT systems that are not inter-operable & a high degree of caution with regard to information sharing."
"Several policy barriers will need to be addressed. Potential savings associated with integrated services (are) challenging to achieve as a result of separation of budgets...and the incentive created by the Payment by Results system to maintain or increase activity in secondary (hospital) care."
The Kings Fund - Long Term Conditions & Mental Health - February 2012.
What we need is a complete review of interventions for elderly people with any chronic conditions. I found it amazing & unacceptable when I was involved with the Expert Patient Programme that many GP surgeries do not seem to collect data systematically on the number of patients with chronic conditions, those with multiple chronic conditions, what the prevalence of each condition is & what medications / treatments were being prescribed.
I have 5 chronic conditions. All are dealt with separately, no one looks at the whole person. The patient is passed like a parcel from specialist to specialist. Each medic only unwraps one layer of paper & no one gets to the core. My surgery specifies that patients only bring one illness / symptom to a consultation. I can well understand the time constraints on busy GP's, but it isn't good for patients.
Some symptoms are common to many chronic conditions - pain, sleep disturbance, fatige, anxiety.....These symptoms can & should be managed by informed patients taking responsibility for themselves. But they need information & help from professionals or experienced lay people.
The NHS is too hierarchical with jealously guarded borders & fiefdoms. Until the whole patient & his / her needs are genuinely put at the centre of the NHS costs will escalate & waste will continue. Worse still the patients needs won't be met & they won't get the care they deserve.
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