Long-term conditions and vulnerable groups

We’re monitoring trends in the quality of care for people with serious illnesses, who require long-term support.

Indicator update

Published: 24/02/2022

In this QualityWatch update we look at a range of performance measures for the care of people with long-term conditions, disabilities and serious diseases such as stroke and heart attack, to give a view of how services have fared over the last decade and throughout the Covid-19 pandemic. 

At the start of the Covid-19 pandemic, the NHS rearranged its services in an effort to reduce burden and release capacity to respond to increased hospitalisations; this has had an impact on care for serious and long-term conditions. For example, cardiac rehabilitation services were reduced or suspended so that staff could be redeployed elsewhere. The success rates of reablement services for older people decreased in 2020/21. For the first time this decade, fewer than 80% of people aged 65 and older remained at home three months after discharge to reablement services.

Data collections to measure quality for different serious diseases were also affected. For the Chronic Obstructive Pulmonary Disease (COPD) clinical audit, data submissions between March-September 2020 fell to less than 50% of pre-Covid participation rates and have not been reported. The Sentinel Stroke National Audit Programme created a smaller Covid-19 data entry form for trusts to complete. As a result, data for 2020/21 on specific conditions is limited compared to previous years. 

In the social care sector over the last decade, there has been a decline in the use of residential care such as care homes or nursing homes. Admissions to and bed availability for older people’s residential care has decreased while adults who receive support for a learning disability who live at home has increased. The pandemic has exacerbated some of these trends: 2020/21 saw the largest year-on-year decrease in care home admissions for people aged 65 and over in England. This decrease could be understood through many different lenses – access to high-quality care, the cost of care, change in preference for domiciliary care (at home care) and increased deaths in care homes due to the handling of the pandemic. 

Below is a summary of these indicators, with links to charts and more detailed analysis.

Supporting patients to manage their long-term condition(s)

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  • The proportion of patients who feel supported to manage their long-term conditions has decreased over time. Between 2018 and 2021, the percentage of respondents who stated that they definitely had enough support in the last 12 months decreased from 43% to 37%. The percentage who reported that they had not received enough support increased from 21% to 26%.
  • The 2021 GP Patient Survey shows that fewer patients in the younger age groups felt supported to manage their condition than the older age groups - 69% of respondents aged 16 to 24 felt supported, compared with 80% of respondents aged 75 to 84.

Supporting people in employment

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  • The employment rate of people with disabilities decreased slightly, falling to 52% in Q1 2020/21 (April to June 2020), but has since increased again to 54% in Q2 2021/22.
  • The proportion of adults with a learning disability in paid employment has decreased over time, from 6.0% in 2014/15 to a low of 5.1% in 2020/21. A slightly higher proportion of men with a learning disability are employed than women; in 2020/21, 4.4% of women with a learning disability were in paid employment compared to 5.7% of men.

Adults with learning disabilities who live in their own home or with their family

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  • The percentage of adults aged 18-64 in England who received long-term support for a learning disability and live at home or with their family, increased from 74% in 2014/15 to 78% in 2020/21.
  • This varied across the regions in England: in the North West, 87% of adults with a learning disability lived at home, compared to 71% in the West Midlands.

Care for COPD patients 

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  • Chronic obstructive pulmonary disease (COPD) is a group of common lung diseases that makes breathing difficult.
  • The provision of timely care for patients with COPD exacerbations has improved over time. The percentage of hospital admissions that were reviewed by a member of the respiratory team increased from 77% in 2014 to 87% in 2018/19; in 2019/20, 88% of admissions were reviewed. 
  • In 2019/20, of patients admitted who were current smokers, only 53% were referred to a behavioural change intervention or prescribed smoking cessation pharmacotherapy during their admission.

Care for heart attack patients

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  • Non-ST-elevation myocardial infarction (nSTEMI) is a kind of heart attack where there is a partial blockage to one of the arteries, causing reduced oxygen flow to the heart muscle. NICE guidelines state that all nSTEMI patients should have an angiography (an X-ray scan of your heart) within 72 hours of first admission. 
  • In 2019/20, 55% of patients with nSTEMI who underwent angiography did so within 72 hours, the same proportion of patients as in 2010/11. This demonstrates an area for significant quality improvement, although there is considerable variation between hospitals.
  • Percutaneous coronary intervention (PCI) is an initial treatment to reduce the severity of a heart attack. The time between arriving at hospital and receiving a primary PCI have remained stable in recent years, however the percentage of patients receiving primary PCI within 150 minutes of calling for help (CtB) has decreased over the last six years, falling in 2019/20 to the lowest level for the last decade.

Stroke care 

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  • People presenting with acute stroke should be diagnosed, scanned and have urgent treatment when it is needed in A&E, and then be admitted directly to a specialist stroke unit as soon as possible. Quarterly data shows that in April-June 2020, 63% of patients were admitted within four hours, this fell to 50% in January-March 2021.
  • It is also important for stroke patients to receive all of the necessary assessments by a multidisciplinary team in a timely manner. Between 2013/14 and 2020/21, the proportion of patients receiving a timely multidisciplinary review increased from 44% to 66%.

Injuries due to falls

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  • The percentage of hip fractures that occurred in hospital varies across Northern Ireland, England and Wales. It is highest in Wales; a peak of 7.7% was reached in November 2013, but it has since decreased to 5.0% in November 2021. In England, hip fractures as a result of inpatient falls decreased from a high of 5.4% in February 2013 to a low of 2.9% in November 2021. There is a general upwards trend for Northern Ireland, according to their latest figures in January 2020, 2.3% of hip fractures occurred in hospital.
  • The percentage of hip fracture cases having surgery within 36 hours has decreased gradually over time in England from 77% in January 2015 to 67% in December 2021. For the same time period in Wales, this percentage increased from 64% to 66%. Northern Ireland has a lower percentage of prompt surgery, only 21% of hip fractures cases had surgery within 36 hours in January 2020.

Supporting older people’s recovery after illness or injury 

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  • To measure the effectiveness of rehabilitation services we measure the proportion of people aged 65 and over who are still at home 91 days after discharge from hospital into reablement services; In 2020/21 this proportion fell below 80% for the first time in a decade, to 79%.
  • 81% of women (aged 65 and over) were still at home 91 days after discharge, compared to 77% of men in 2020/21. When broken down by age group, 77% of those aged 85 and older remained at home 91 days after discharge, compared to 81% of people aged 65-84. 
  • Whilst the proportion of older people (aged 65 and over) who received reablement services increased from 2.6% in 2019/20 to 3.1% in 2020/21, the actual number of older people who received reablement services decreased from 43,335 to 43,193.

Care home bed availability 

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  • Between 2012 and 2021, the number of beds in care homes for people aged 75 and over declined from 11.3 per 100 people to 9.4 per 100 people – a 16% decrease.
  • In the same time period, the number of nursing home beds for people aged 75 and over decreased from 5.2 per 100 people to 4.6 per 100 people – a 12% decrease.

Admissions to care homes

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  • For adults aged over 65, 498 per 100,000 people were admitted to a residential or nursing care home in 2020/21 – a 15% decrease from 2019/20 and a 24% decrease from 2014/15.
  • Admissions for younger adults, between 18-64, has varied little since 2014/15. On average, 13.7 per 100,000 people are admitted to residential or nursing care homes for long-term support needs. 

Carers’ views of social care quality 

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  • In 2018/19, 38.7% of carers were ‘extremely’ or ‘very’ satisfied with the support or services they and the person they care for had received, compared with 39% in 2016/17.
  • Between 2012/13 and 2014/15, the proportion of carers who were ‘extremely’ or ‘very’ satisfied decreased from 43.1% to 41.1%, and the proportion who were ‘extremely’ or ‘very’ dissatisfied increased from 4.3% to 5.1%.

Carer-reported quality of life

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  • Between 2016/17 and 2018/19, the average carer-reported quality of life score decreased from 7.7 to 7.5 (out of a maximum score of 12). Carer-reported quality of life scores were 0.3 points higher in men than women across all years.

Social care users and safety 

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  • The Personal Social Services Adult Social Care Survey (ASCS) asks service users if care and support services help them feel safe. Between 2014/15 and 2019/20, the proportion of service users who responded “Yes” they do help them feel safe increased slightly from 85% to 87%.

End of life care

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  • Between 2009 and 2019, the proportion of people with three or more emergency admissions in the last three months of life increased from 5.6% to 8.1%.
  • 52% of those who died in 2020, died in their usual place of residence, an increase from 35% in 2004 to 47% in 2019.
  • The proportion of people who died in their usual place of residence varied by region in 2020 – the highest being in the South West with 59% and lowest in London with 45%.