Multimorbidity: Despair is not a Strategy

The causes of the current NHS crisis are multi-factorial. Many of these causes are disputed but there is consensus around the impact of demographics. Commentators point to an ageing population (a good thing) and the rising number of people with long term conditions (a bad thing). What is indisputable is that the population in England has both grown and aged since 2010[1]

People talk of a direct relationship between an ageing population and the growth in numbers of people with long term conditions. In truth the position is a more nuanced than this.

Evidence shows that the burning platform is multimorbidity and whilst the presence of two or more long-term health conditions in a single individual increases with age, we should not assume that you have to be old to be multi-morbid.

Although common in older people, multimorbidity does also occur in younger people.

Taking a holistic view of multimorbidity is critical to our understanding. Evidence shows that there is a strong link between socioeconomic deprivation and multimorbidity. Indeed, multimorbidity occurs 10-15 years earlier in people living in the most deprived areas than it does in people living in the most affluent areas[2].

At their heart Population Health Management (PHM) programmes are data driven endeavours and a sound PHM programme will follow Evidence Based Practice (EPB). The evidence from our Sollis PHM work is clear. Multimorbidity is now the norm and yet the simple truth is that the current healthcare system in the UK is not designed to support people with multiple conditions.

This state of affairs is having a direct impact on individual quality of life. People living with multimorbidity are at a greater risk of negative outcomes such as increased mortality, lower quality of life and greater use of healthcare services including unplanned care.[3]

Which takes us back to those causes of the current health and care crisis of which a greater use of unplanned care is an aspect.

Because the causes of the current crisis are multi-faceted, we must accept that we are not going to change the system overnight. Our ability to address and reverse the historic under-investment in the NHS and social care over the past thirteen years is beyond our immediate control.

To recognise this truth is not to accept defeat. Vital that we don’t sink into a pit of despair. What we need is hope. What we need is strategy.

It is entirely within our control to re-imagine how we re-design and transform services that deliver better care and better outcomes for people with multiple health conditions.

The starting point of this journey is an understanding of the needs, wants and desires of the individuals in these populations who are living with multimorbidity. Who are they? Where do they live? What is happening in their day to day lives that impacts on their health status? What do good outcomes for these people look like?

And we desperately need more evidence about the lived experience of people with multimorbidity.

In the meantime, data and tooling is available now which can help us build a strategy. That strategy is Population Health Management.

So, a simple starting point might be the following:

  • Undertake segmentation analysis to understand the impact of multimorbidity within targetable cohorts.
  • Undertake gap analysis to see whether people with multimorbidity are having their needs met or their care adequately coordinated.
  • Interrogate the data to identify areas such as unwarranted variation in activity and cost.
  • Be forensic in an examination of health inequities faced by people with multimorbidity.
  • Begin the process of designing intervention programmes that could be delivered within a non-acute setting and which are based on best practice.
  • Do something!

We need to run the data with a view to developing a holistic understanding of multimorbidity in local populations. And importantly we need to speak directly and meaningfully to those with lived experience and capture both their voice and the voices of the communities within which they reside.

We need to listen. Deeply.

Only then can we begin the process of planning for a better world for these populations.

All of this is in our control.

No-one is suggesting there is a quick fix to the system wide problems behind the current health and care crisis. However, despair is not a strategy.

Hope is a waking dream[4] and some quick wins are within reach.

Nigel C Slone

[1] David Oliver

[2] Richmond Group of Charities – “Multimorbidity. Understanding the challenge” January 2018.

[3] Richmond Group of Charities – “Multimorbidity. Understanding the challenge” January 2018.

[4] Aristotle