NHS 'can't cope' with multi-disease patients

The health system in the UK cannot cope with the rising number of under-65s with long-term medical conditions and needs "radical change", says a study in The Lancet.

A team of researchers analysing 1.75 million people in Scotland found that nearly a quarter had two or more chronic diseases.

Their care was often co-ordinated poorly and inefficient, the study said.

The team wants a more personal approach to patients with complex problems.

At present, healthcare services, medical research and the education of medical students are dominated by a focus on individual diseases, the study authors say.

Yet rising numbers of people are living with more than two long-term disorders, called "multimorbidity", which could include coronary heart disease, diabetes, cancer, stroke and depression.

In general, people with multimorbidity are more likely to live in deprived areas and have a poorer quality of life. Their care is fragmented because they see a number of different specialists.

The study , led by Bruce Guthrie, professor of primary care medicine at Dundee University, Professor Stewart Mercer, of Glasgow University, and Graham Watt, professor of general practice at Glasgow, says this approach should change.

"Existing approaches need to be complemented by support for the work of generalists, providing continuity, co-ordination, and above all a personal approach for people with multimorbidity."

Their study of nearly two million patients registered with 314 medical practices in Scotland showed that people living in the most deprived areas were particularly affected by long-term physical and mental disorders.

These disorders were more common among poorer communities and occurred 10-to-15 years earlier than among those living in affluent areas.

The study looked for 40 chronic conditions among the participants' data.

Researchers found that 42% of patients had one or more conditions and 23% had two or more.

It also found that only 9% of those with coronary heart disease, had that one disease alone.

Similarly, only 23% of those with cancer, had only cancer and no other long-term disease.

Although the prevalence of multimorbidity increased with age and was present in most people aged over 65, the actual number of people with multimorbidity was higher in those under 65, the study said.

Graham Watt, professor of general practice at Glasgow University, said this was a problem affecting many countries, not just Scotland.

"Any country with an ageing population is heading in this direction. All these countries are waking up to the problem.

"The status quo isn't an option because it leads in the wrong direction."

Prof Watt said that rather than more specialists, patients with multiple conditions "need someone who can oversee all the problems of a patient".

"These patients need continuity, and we need ways of measuring how well care is joined-up."

In an accompanying article in The Lancet, Dr Chris Salisbury, from the School of Social and Community Medicine at the University of Bristol, said the increasing proportion of people with several co-existing medical problems had a financial impact.

"Expenditure on health care rises almost exponentially with the number of chronic disorders that an individual has, so increasing multimorbidity generates financial pressures. This economic burden heightens the need to manage people with several chronic illnesses in more efficient ways," said Dr Salisbury.

Dr Salisbury suggests that general practitioners in more deprived areas should have lower caseloads to account for higher levels of multiple morbidity.

He also says that in hospitals, those with multimorbidity should be assigned to a generalist consultant who would be responsible for co-ordinating their care.

The Scottish Government's Health Secretary, Nicola Sturgeon, said: "We are working in partnership with NHS, primary-care providers and patients, as well as the research community, so that we have effective systems in place to address the needs of people with multiple health conditions and to reduce these health inequalities."

A spokesperson from the Department of Health said the changes to the NHS and social care system in England were aiming to focus care on individual needs.

"This includes proper management of people's conditions in their own homes and in the community, in order to minimise unnecessary and avoidable visits to hospital.

"Greater use of telehealth and a focus on prevention will help people care for themselves and manage their conditions better.

"Our reforms are improving integration of health and social care services, ensuring each individual is treated with the dignity and respect they deserve."