Management of chronic conditions: Experience and lessons from the English National Health Service

Chronic illness is the principal modifier of health status and quality of life internationally. These long-term and irreversible conditions affect people of all ages, but especially the elderly population. Given the growing number of people with chronic conditions, the complex clinical and service delivery challenges involved, and the enormous costs of care, health systems around the world are searching for better approaches to chronic illness management. The English National Health Service (NHS) has made chronic care a major priority, and the initiatives implemented are many and varied. Despite major system differnces between our two countries, the English experience still offers the U.S. some valuable lessons. This paper will first examine the challenges of chronic illness and the need for broad strategies to manage the care, outcomes and costs of these difficult conditions. This will be followed by a description of the range of chronic disease management approaches undertaken by the English NHS, including a review of key experiences, challenges, lessons and contributing factors--both pro and con. The paper will conclude with a discussion of the implications for the U.S.