Older people with social care needs and multiple long-term conditions

Context

A long‑term condition is one that generally lasts a year or longer and impacts on a person's life. Examples include arthritis, asthma, cancer, dementia, diabetes, heart disease, mental health conditions and stroke. Long‑term conditions may also be known as 'chronic conditions'.

The prevalence of long‑term conditions is strongly linked to ageing and the number of people with multiple (more than 1) long‑term conditions in England is projected to rise to 2.9 million by 2018 (Department of Health's Long term conditions compendium of information third edition). Prevention, delaying onset and slowing the progression of long‑term conditions are all important outcomes for older people. Other important outcomes include quality of life and positive experience related to independence, choice, dignity and control.

Despite recent policy focusing on integrated health and social care services, some people are still being treated as a collection of conditions or symptoms, rather than as a whole person (Department of Health's mandate: a mandate from the government to the NHS Commissioning Board: April 2013 to March 2015). People with multiple long‑term conditions want joined‑up, coordinated services but often find they are hard to access and fragmented (Department of Health's Integrated care and support: our shared commitment). Poor mental health can be associated with both social isolation and poor physical health, and can go unnoticed. The issue of delivering integrated support to people with long‑term conditions who live in nursing and care homes has also been neglected (British Geriatrics Society's A quest for quality in care homes; Care Quality Commission's Health care in care homes).

The Department of Health and Social Care asked NICE to develop an evidence-based guideline, on older people with social care needs and multiple long-term conditions, to help address these issues. The guideline was developed by a guideline committee following a detailed review of the evidence. The guideline focuses on older people with social care needs and multiple long‑term conditions and their carers. The guideline does not cover younger adults (although many of the recommendations may also be relevant to younger adults). This is because the largest group of people affected by multiple long‑term conditions is older people and because older people can experience inequalities in terms of resource allocation which is in the context of decreasing resources available to them overall (Joseph Rowntree Foundation's Older people's vision for long-term care, What is social care, and how can health services better integrate with it? British Medical Association).

This guideline considers how person‑centred social care and support for older people with social care needs and multiple long‑term conditions should be planned and delivered. It addresses how those responsible for commissioning, managing and providing care for people with social care needs and multiple long‑term conditions should work together to deliver safe, high‑quality services that promote independence, choice and control. It is relevant to all older people with social care needs and multiple long‑term conditions, including those living in their own homes, in specialist settings or in care homes.

This guideline has been developed in the context of a complex and rapidly evolving landscape of guidance and legislation, most notably the Care Act 2014. While the Care Act and other legislation describe what organisations must do, this guideline is focused on 'what works' in terms of how to fulfil those duties, and deliver support to older people with social care needs and multiple long‑term conditions.

The guideline will complement a range of NICE guidelines on topics such as dementia, diabetes, hypertension, mental wellbeing and older adults, and Parkinson's disease.