It is estimated that 17.5 million people in the UK suffer from a long-term chronic disease such as arthritis, asthma and diabetes for example.  Chronic conditions in most instances cannot be cured only controlled.  These are often lifelong and limiting in terms of quality of life, needing self managing and ongoing care.

The aim of the Case Manager's role is to look after the day to day management of clients with Chronic Disease following an exacerbation of their condition.

The Case Manager will undertake a comprehensive assessment in conjunction with the client and their carers with the aim of assisting the client to achieve their best possible level of health, well being and independence.  By educating clients and carers to recognise signs and symptoms of deterioration in their condition, planning of appropriate action to avoid exacerbation and deterioration in their health, the Case Manager aims to improve the quality of life for these clients and their carers.

This will be the process by which the Case Manager will plan, co-ordinate, manage and review the care of individuals to improve their quality of life.

When a client / patient is referred to the Case Manager they will make an appointment to visit that person at home.  During this visit the Case Manager will discuss with that person and / or carer how they manage their day to day living.  During this assessment she will then be able to discuss their concerns and make a plan of action on what can be achieved.  The Case Manager will, with the person's consent, discuss these concerns with different members of the multidisciplinary team to find a way of solving their concerns.

A follow up appointment or a telephone contact will be arranged to discuss issues that may have arisen and ensure that plans agreed were carried out.

Patients can be referred to the Case Manager for an assessment from their GP, Consultant, Specialist Nurse and all members of the Multidisciplinary Team.