People powered health: technology enabled care for long-term conditions Rachel Power, Tara Donnelly and Prof Alf Collins on transforming care for those living with long-term conditions through technology-enabled support. The scale of the challenge Over 25 million people in England live with a long-term health condition (LTC), over 2 in 5 (44%) of the current population, with 24% living with 2 or more conditions. While the NHS has made strides in acute care, supporting people to live well with LTCs remains a critical challenge. LTC management accounts for more than 70% of money spent on health and social care in England, yet current care models often fail to meet patient needs effectively. The Current Care Gap People living with LTCs consistently report challenges with: fragmented care delivery across NHS and social care, poor communication between services, significant disconnect between primary and secondary care, limited access to timely support when health deteriorates, difficulty managing multiple conditions effectively. “You feel sort of worthless, like you’ve lost your dreams…it just feels like you’re being left behind”. Health inequalities and long-term conditions: a cycle of disadvantage The challenges of living with long-term conditions are deeply intertwined with wider social determinants of health. Research from The King’s Fund reveals clear patterns of inequality: people from lower socioeconomic groups face a disproportionate burden - they are not only more likely to develop long-term conditions but also experience worse health outcomes, people from racially minoritised groups report higher rates of long-term conditions and lower overall quality of life, one-fifth of working-age people report having a long-term condition that limits their ability to work. ‘Not being able to work affected me far beyond just finances. I stopped feeling like I was contributing to society, which sent my mental health into a downward spiral. This triggered my anxiety and depression, making it even harder to manage my other health conditions. It's a vicious cycle that impacts every aspect of life’. The challenge of engagement Twenty-three years ago, Sir Derek Wanless set out a vision for a 'fully engaged scenario in healthcare’. Yet today, approximately 35% of people living with long-term conditions still struggle to engage with their health - 20% actively avoid thinking about their health, while another 15% show low engagement levels. This creates a cycle where disengagement leads to poorer outcomes and widening inequalities, particularly affecting those already facing social and economic disadvantages. Despite Wanless's early warning, the challenge of building knowledge, skills, and confidence for self-management remains a critical barrier to improving outcomes. Why technology matters: patient experiences Callers to the Patients Association helpline and our focus group participants consistently highlight how fragmented care impacts their daily lives. Their experiences demonstrate why technology-enabled coordination is crucial: "I'm constantly having to be my own care coordinator," "I'm juggling appointments between my GP and hospital teams, chasing test results, and explaining my conditions over and over." Technology could help bridge these gaps through shared care records and coordinated communication systems. The impact of disconnected care is particularly evident in medication management. "My specialist recommended changes to my medication, but three weeks later my GP still hadn't received the information. Meanwhile, I was stuck in limbo, unsure which medicines to take" Evidence shows that better connected care through well designed technology can deliver: reduced appointment duplications, better medication management, greater patient activation, more timely interventions, fewer crisis presentations, more effective use of specialist expertise. These improvements matter because they directly address what patients tell us they need: simpler ways to manage their conditions, better coordination between services, and less time spent navigating the system. Making technology work for everyone Success requires reaching beyond traditional engagement approaches to ensure we hear from those whose voices are often excluded: proactively seek out diverse experiences through community outreach, work with trusted organisations and community leaders, recognise and value different forms of knowledge and expertise, build feedback mechanisms that work for different communities, address barriers to engagement (language, cultural, social, practical), never assume that someone may not want to engage (a common misconception relates to older people) but offer to all equally. Any technology-enabled solutions must explicitly address inequalities by: ensuring accessible and simple design for varying levels of health literacy, providing devices and data access where needed, offering support in multiple languages, maintaining non-digital alternatives so that people can call in readings, building confidence through providing support, including peer support. Evidence of Impact Recent evidence demonstrates how well-designed technology-enabled care can transform outcomes while reaching those most in need. Managing Heart Failure @ Home Programme (2023-2024) This innovative approach, implemented across 10 NHS sites, demonstrates the potential for technology to improve both patient outcomes and system efficiency: Clinical impact: significant reduction in symptoms, 32% reduction in GP visits at six months, improved integration between primary and secondary care, better medication management. Patient experience: increased confidence in self-management, improved health-related quality of life, greater ability to manage symptoms at home, better access to clinical support when needed. Challenging common assumptions While some worry that home-based care increases pressure on primary care, the evidence shows the opposite. The one-third reduction in GP visits across all sites suggests that giving patients rapid access to clinical expertise and real-time result sharing actually reduces primary care burden. Scaled nationally, this could significantly impact GP capacity. Reaching those most in need: Chronic obstructive pulmonary disease (COPD) innovation Success in COPD management demonstrates how technology can address health inequalities: Bristol, North Somerset and South Gloucestershire's living with COPD service: successfully reached the most deprived populations (19% from individual measure of deprivation (IMD) 1, compared to Integrated care board (ICB) average of 9%), 40% of participants from IMD 1-3, provided comprehensive support including devices, data, remote monitoring, and health coaching, demonstrated that digital inclusion is possible with the right support. Wider system impact: Airedale Hospital achieved 41% reduction in emergency admissions, multiple regions (Cambridgeshire, Leicester, Frimley) showing success with high-risk patients, improved coordination between primary and secondary care, more efficient use of specialist resources. These results challenge the notion that technology-enabled care excludes disadvantaged populations. Instead, they show that well-designed programmes can effectively reach and support those who need it most. International momentum The UK is well-positioned to build on growing international evidence: France has legislated to extend remote monitoring based on clinical need Denmark has committed to universal remote monitoring for severe COPD UK Virtual Wards currently have the infrastructure to support over 12,000 patients a month. Technology enabled transformation. The next steps Technology offers transformative potential to scale support for people living with long-term conditions, particularly those facing the greatest challenges. Through well-designed digital solutions, we can enable proactive care through remote monitoring, allowing early intervention before health deteriorates. These solutions can facilitate seamless coordination between primary, secondary, and community care services, while supporting self-management through personalised digital tools. Most importantly, they can provide rapid access to clinical expertise when needed and connect people with vital peer support networks and community resources From innovation to implementation: building a digital future Successful implementation must address digital exclusion head-on, providing devices and connectivity where needed. Integration with existing NHS infrastructure, particularly Virtual Ward platforms, will be crucial for sustainability. Meanwhile, support for remote prescribing and medication management needs to work alongside digital health coaching and social prescribing, creating strong links with community and third sector services. This approach represents more than incremental change - it's an opportunity to fundamentally shift from a crisis-response model to one that is empowering, proactive, and provides ready access to clinical advice from home. However, this transformation can only succeed through genuine partnership with patients and communities. “We have a major opportunity right now to move healthcare to being much more proactive and personalised, and an urgent need to do so. I am impatient to see the NHS establish this model of remote monitoring support for those at greatest risk of admission and deal with issues at a much earlier point, as the evidence shows this is so much better for people and the NHS alike, as it reduces unnecessary hospital admissions. Like Denmark, I’d like to see this model scaled across the NHS, as part of our work to make the three shifts – from hospital to home, analogue to digital, treatment to prevention – a reality” - Tara Donnelly The path forward To realise this potential, we must start with patient partnership. This means engaging diverse voices in service design and implementation, valuing different forms of knowledge and lived experience. We need to create feedback mechanisms that work for all communities, ensuring participation is accessible and inclusive. The NHS 10-Year Plan presents a crucial opportunity for a sea change in how we support people with long-term conditions. Rather than continuing with a system focused on managing crises and exacerbations, we can create a proactive model that helps people stay well at home. This transformation requires integrated care models that combine digital capabilities with personalised support, fundamentally shifting how care is delivered. Digital inclusion requires more than just providing devices and connectivity - it means offering flexible support options, addressing practical barriers to access, and maintaining alternative pathways for those who prefer them. Throughout this transformation, we must measure what matters to patients, tracking impact on health inequalities and monitoring both clinical and quality of life outcomes. The technology exists, and the evidence is compelling. With genuine patient partnership and a commitment to inclusive implementation, we can create a healthcare system that truly works for everyone living with long-term conditions. The time for transformation is now. Authors Rachel Power is the Chief Executive at the Patients Association, a charity an independent patient charity campaigning for improvements in health and social care for patients. Tara Donnelly is the Founder of Digital Care a firm that works with NHS organisations and digital innovators with a focus on tech enabled home care. She was previously the Chief Digital Officer for NHS England. Professor Alf Collins is a freelance health consultant. From 2016-2023, he was NHS England’s National Clinical Director for personalised care. He is also a trustee of the Patients Association. The Patients Association Freephone helpline The Patients Association's free and confidential helpline is open Monday to Friday from 9:30 AM to 5 PM. You can contact the helpline by either: Calling 0800 345 7115 from a landline or mobile phone Or emailing [email protected] Manage Cookie Preferences